395 12TH ST - PLUMBING ' ;j1 S CITY OF ATLANTIC BEACH
"� ) 800 SEMINOLE ROAD
J M " 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-1612
Job Type: PLUMBING ONLY
Description: install 2 bathtubs, 1 washer, 1 dishwasher, 2 hose bibs, 1
kitchen sink, 1 laundry tray, 6 lavatories, 3 showers, 4 toilets, 2 water heaters
Estimated Value:
Issue Date: 7/18/2016
Expiration Date: 1/14/2017
PROPERTY ADDRESS:
Address: 395 12TH ST
RE Number: 171922-0000
GENERAL CONTRACTOR INFORMATION:
Name: CRABTREE PLUMBING INC
Address: 2351 URBAN RD QA JEFFREY W. CRABTREE
Phone: 904-384-4604
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $161 .00
Trade Permit Base Fee $55.00
I
Total Payments: $220.00
PERMIT IS APPROVED ONLY IN ACCORDANCE \VITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 1,p— 0-661— t Ib l .
JOB ADDRESS: 39 5 I L*€ed PERMIT# ii.,0-5a--/06
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 1.-' Septic Tank& Pit
Clothes Washer I Shower 3
Dishwasher __I_ Shower Pan •
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink ,
Floor Sink Toilet
Hose Bibs 'Z.— Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray I Water Connected Appliances
Lavatory 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 ci Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
o Lawn Sprinkler System-Number of Heads Li 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 NMQ.t i(U.,9 A()Nr-f-'Q V,C-'Q Phone Number%q 43)- 5k1-1Plumbing
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Plumbing Company era-1940 e c tik I �.., , Office Phone50q-�gf--'aa0t Fax q- 1(-- g$(141-45-
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Co. Address: 2.-- S1 j,44'47c&ri t'�U /1e_ State
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License Holder(Print): .) 4 ' / L b-kQ-L -- State Certification/Registration# WO 2> -&1
Notarized Signature of License Holder . --------- ~
Before is I •ay of V us'_ 0
4O'p0.Y•Pf'Bec KAREN SNDZINSKI
* (_)' * MYCOMMISSION AEE214611 Si nature ofP eli. ��A. 4 /
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t EXPIRES:October 6,2016 g Notary —
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