338 4TH ST - PLUMBING , i-- J e., '
�' ' '` S, CITY OF ATLANTIC BEACH
L "`�, f 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-680
Job Type: PLUMBING ONLY
Description: 26 fixtures
Estimated Value:
Issue Date: 3/21/2016
Expiration Date: 9/17/2016
PROPERTY ADDRESS:
Address: 338 4TH ST
RE Number: 169818-0000
PROPERTY OWNER:
Name: STEELE, JAMES V
Address: 1874 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: NELSON PLUMBING CO. INC.
Address: 11624 -1 DAV E DAVIS CREEK RD QA SCOTT GARY
NELSON
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State PLMG DCA Surcharge $2.00
State PLMG DBPR Surcharge $2.00
Plumbing Fixtures $182.00
Total Payments: $241.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
, Ph(904) 247-5826 Fax(904) 247-5845
JOB ADDRESS: 338 y ST{Z. C-C- PERMIT# I6-SF?---339
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub _ a Septic Tank&Pit 1-_---X Clothes Washer __L__ Shower
Dishwasher _i___ Shower Pan g-
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 3
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray t Water Connected Appliances
Lavatory S Water Heater —1_._. 2 °
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:
Li Sewer Replacement 0 Back Flow Preventer Li Grease Interceptor(Trap) gallons(Requires 3 sets of pt-
o Lawn Sprinkler System-Number of Heads 0 Well .
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspectioi:
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
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 specii
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 constructic
Property Owners Name H DES 16N Phone Number
Plumbing Company Afe LSO P UW1P,ir�16 `n Q Tn1 C Office Phone q0 t 2b2.t[6$t/Fax _.
Co.Address: ,2 -( )f}VlS CQce.- • + C ► 3-Ac.awkii ((C State R. Zip 32256
License Holder(Print): CO TT rc LSO, /Wi it - Certificati.on/Registration# 020 3'7 l r
NQ I:::, ;, t:, egos All/.IIiii/I/ •
E •. MY COMMISSION t FF 900342 1/r 7 V r. • '
EXPIRES'November 16,2019 ' Sworn an r .scribed befor- me� of (A-t-C 20
'Qr;;�" bonded MN Notary Publu Underwriters
— Signature of Notary Publicra. / 1 0 ✓�