1845 HICKORY LN PLBG PERMIT fy1,y y�J
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
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-1372
Jab Type: PLUMBING ONLY
Description: PLUMBING - 3 FIXTURES
Estimated Value:
Issue Date: 6/14/2016
Expiration Date: 12/11/2016
PROPERTY ADDRESS:
Address: 1845 HICKORY LN
RE Number: 172020-1436
PROPERTY OWNER:
Name: MCMENEMY, THOMAS M 8 PATI J, '
Address: 1845 HICKORY LN
GENERAL CONTRACTOR INFORMATION:
Name: STEEG PLUMBING
Address: 1601 MAIN ST QA JAMES STEEG
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $21.00
Trade Permit Base Fee $55.00
Total Payments: $80.00
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
QQ�uI
Ph(904) 247-5826
h(904) 247-5826 Fax (904)247-5845 �p - P�,�_ 3-7 7
JOB ADDRESS: �D-y',5 /7/ d�.i /,QO'L' PERMTT# ` i
NEW OR REPLACEMENT INSTALLATION: Project Values
TYPE of FIXTORE QTY TYPE of FIXTORE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower /vew
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink —�b
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Trayp Water Connected Appliances
Lavatory —�4"C�'� Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE OFFixTuRE 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 Tiny 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 **
**SIRWD 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 /f'itp7 `V, JV-,P-w Y wr u Phone Number
Plumbing Company /�� Office Phone '511J Fax
Co. Address: /d& [4Iw S City-fes--State�� Zip 3Z2�}3
License Holder(Print): ) 7n G State Certification/Registration# A�'L0371 0
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Notarized Signature of License Holder II
urTcO dM s c!�fslm is day f 20 v
c P!FE"a October 8,Y01a
'' •, `' - . a'o:ar� f Notary Public