697 BEACH AVE PLBG PERMIT CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
!9 '� ATLANTIC BEACH,FL 32233
- w. INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-1559
Job Type: PLUMBING ONLY
Description: install 5 new fixtures
Estimated Value:
Issue Date: 7/12/2016
Expiration Date: 1/8/2017
PROPERTY ADDRESS:
Address: 697 BEACH AVE
RE Number: 170119-0000
PROPERTY OWNER:
Name: WENTZ ET AL, WILLIAM MICHAEL
Address: 99 N LINCOLN AVE
PROPERTY OWNER:
Name: COLLINS JTRS, ZANE MICHAEL
Address: 99 LINCOLN AVE
GENERAL CONTRACTOR INFORMATION:
Name: COGBURN AND WAKEFIELD PLBG
Address: 5900 TOWNSEND BLVD APT 522 QA JOHN COGBURN
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $35.00
Trade Permit Base Fee $55.00
Total Payments: $94.00
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 ( (p, 7P'-( 7 1-enol
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JOB ADDRESS: ( -BeA" (f}ve MI
PERT# 6lp'
NEW OR REPLACEMENT INSTALLATION: Project Value s
TYPE OF FIXTURE QTY TYPE OFFIXTU QTy
Bathtub
Clothes Washer Septic Tank&Pit
`—
Dishwasher Shower
Shower Pan
Drinking Fountain Slop Sink —'—
Floor Dram Three Compartment Sink _—
Floor Sink Toilet
Hose Bibs Z Urinal —1—
Kitchen Sink Vacuum Breakers _—
Laundry
ndry Tray Water Connected Appliances
Other Fctures = Water Heater
Water Treating System _
RE-PIPE:
TYPEoFF1XTORE QTY TYPE oFFIXTTIRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan —
Floorng Fountain Slop Sink —
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal —
LaundnSink Vacuum Breakers —
Lavaor Trey Water Connected Appliances
Other
Lavatory Water Heater
Other Ftxtmes Water Treating System
MSCELLANEOUS:
I Sewer Replacement ❑Back Flow Preventer ❑ Grease Interceptor(Trap)_gallons(Requires 3 sets of plans)
I Lawn Sprinkler System-Number of Heads ❑ Well **
*VAWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
I Other
mut becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.I hereby eetfy that I have read
s 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
not. The permit does not give authority to violate the pro`�/ions of my other state or local law regulation construction or the performance ofconshucam.
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operty Owners Name�(n 0- k / 0-r C u ((rQ I'h C"Phone Number 96'11- 7 -11-o.320
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i. Address: (0909 �t-G City TAS State f2 Zip 2Z/0
cense Holder(Print): a L.rn Ca �oaaa.J to Certification/Registration# e-Pe-/4 L S I NO
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