42 11TH ST - PLUMBING (-----j \J .
JJ
`SS CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
V � yr 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-1098
1 Job Type: PLUMBING ONLY
Description: new plbg service 36 fixtures
Estimated Value:
Issue Date: 5/11/2016
Expiration Date:
11/7/2016
PROPERTY ADDRESS:
Address: 42 11TH ST
RE Number: 170269-0000
PROPERTY OWNER:
Name: TUCKER TRUST, ADELAIDE R
Address: 42 11TH ST
GENERAL CONTRACTOR INFORMATION:
Name: SUNSHINE STATE PLUMBING
Address: 1340 TRAILWOOD DR MICHAEL TROY PORTER
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State PLMG DCA Surcharge $2.00
State PLMG DBPR Surcharge $2.00
Plumbing Fixtures $252.00
Total Payments: $311.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: 42 11TH STREET PERMIT# 16-SFR-685
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 2 Septic Tank&Pit
Clothes Washer 2 Shower 1
Dishwasher 2 Shower Pan 2
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 6
Hose Bibs 5 Urinal
Kitchen Sink 3 Vacuum Breakers
Laundry Tray 2 Water Connected Appliances 2
Lavatory 7 Water Heater 2
Other Fixtures 1)7Water Treating System
RE-PIPE: `/,\D
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 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads 0 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 Beliles Phone Number
Plumbing Company Sunshine State Plumbing Office Phone 904-262-1066 Fax 904-262-0358
Co. Address: 710 Haines Street City Jacksonville State FL Zip 32202
License Holder(Print): Michael T. Porter State Certification/Registration# CFC 1426859
Notarized Signature of License Holder
4.6`'.':•:`.'s4,,,..P[,i94,,, DAVINA R.DICKERSON Sworn and subscribed before me this I day of Alkki 20
Ve*
MY CCMMISSION 1 FF 061309
* EXPIRES:October 22,2017 Signature of Notary Public I d.1% s.
''',,,,,,F„dBonded Thru Budget Notary Services 6r