328 5TH ST - PLUMBING r� f J, ,t5)
� CITY OF ATLANTIC BEACH
_ \s2� 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-1715
Job Type: PLUMBING ONLY
Description: install 3 tubs, washer, 4 hose bibs, 4 sinks, laundry tray, 7
lavatories, shower pan, 5 toilets, 2 trmt systems
Estimated Value:
Issue Date: 7/28/2016
Expiration Date: 1/24/2017 _
PROPERTY ADDRESS:
Address: 328 5TH ST
RE Number: 169834-0000
PROPERTY OWNER:
Name: GOODLING, LOUISE 0
Address: 328 5TH ST
GENERAL CONTRACTOR INFORMATION:
Name: WAYNE CONN PLUMBING INC.
Address: 6915 W BEAVER ST
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $196.00
Trade Permit Base Fee $55.00
Total Payments: $255.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845 / ,- SFA-/-2/3
JOB ADDRESS: 30 g 6774 PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 3 Septic Tank&Pit
Clothes Washer _L_ Shower —07—
Dishwasher Shower Pan _i__ _
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet . S--
Hose
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory I Water Heater
Other Fixtures Water Treating System _
RE-PIPE: v
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: C,?F'' --5-D V
❑ Sewer Replacement ❑ 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 �l/ p Phone Number
Plumbing Company i/ '/tk? (4/i / V 4I 3 Office Phone 3533/6A Fax
. Cit 5-,-01' Statef/ Zip 322/l'
Co. Address: ‘• Ac---
h.) �� Y
License Holder(Print): vE S�� State Certification/Registration # ��c.•//, 3.-S�5'
Notarized Signature of License Holder
;�,.A.t DAYNAH.WIWAMS
Before me this or day of --
.-c--
t4 20 i
`�' � ' MY COMMISSION 4 FF 217841 1
.. ' EXPIRES:August 7,2019 Signature of Notary Public lt' i,U ,,.--
,..,m:31,,, Bonded Thw Notary Pub4c Underwfers
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