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345 4th St - Plumbing 4 Fixtures ms '`"" 's� CITY OF ATLANTIC BEACH , ,_-',, 800 SEMINOLE ROAD J, — -: ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 ,:, J131>� PLUMBING PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814 JOB INFORMATION: Job ID: 16 -PLBG -359 Job Type: PLUMBING ONLY Description: 4 fixtures Estimated Value: Issue Date: 2/12/2016 Expiration Date: 8/10/2016 PROPERTY ADDRESS: Address: 345 4TH ST RE Number: 169837 -0000 PROPERTY OWNER: Name: MCCAWLEY, PETER V & INGRID D, * Address: 320 5TH ST GENERAL CONTRACTOR INFORMATION: Name: FLINT CONSTRUCTION SVCS(PLBG) Address: 1419 LINKSIDE DR QA RUSSELL MARK FLINT Phone: - - FEES: Trade Permit Base Fee $55.00 State PLMG DCA Surcharge $2.00 State PLMG DBPR Surcharge $2.00 Plumbing Fixtures $28.00 Total Payments: $87.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 JOB ADDRESS: < L S I4 54 t/t PERMIT # NEW OR REPLACEMENT INSTALLATION: Project Value $ i,PZ TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank & Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet / Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory 1 Water Heater Other Fixtures Water Treating System RE -PIPE: TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank & Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater Other Fixtures Water Treating System MISCELLANEOUS: ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans) ❑ Lawn Sprinkler System- Number of Heads ❑ Well * * ** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.** ❑ Other Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. / � Property Owners Name TI-c Acre k, t r i Phone Number a o e -q 3 Plumbing Company -� g p Y )�� +" (4 s)K.- c /;),, _C Office Phone y 9Q — Y 0Cv Fax Z7d - f o / Co. Address: / Y17 fir/ .5 City S y' / -(c4 State - Zip � .?So License Holder (Print): 415-e 7/ f/,- '� f State certification/Re # Cfr /2b 77 Votarized Signature of License Holder f 4.. yc� " NoarY riPY l Gra Public State of Mode fore me this 12— da • �, se° j c �os� �4 Sri Q � � my Com mis�c n FF °- S ...nature of Notary Publi ° -! E xpires 021141 — - MP a tr f bF i ti c,