1303 Ocean Blvd Plumbing permit �t.'j 4
CITY OF ATLANTIC BEACH
j 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-2045
Job Type: PLUMBING ONLY
Description: install new tub, hose bib, sink, 2 lavatories, shower pan, 2
toilets, water heater
Estimated Value:
Issue Date: 9/13/2016
Expiration Date: 3/12/2017
PROPERTY ADDRESS:
Address: 1303 OCEAN BLVD
RE Number: 171835-0000
PROPERTY OWNER:
Name: PRIDGEN LIFE ESTATE, MARIAN S, '
Address: 1303 OCEAN BLVD C/O DAVID M PRIDGEN
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $70.00
Trade Permit Base Fee $55.00
Total Payments: $129.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION ld
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Flux (904)247-5845
JOB ADDRES§:, 130 ? Ocean Blvd PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF ForTOR£ QTY TYPE OF FIXTURE QTY
Bathtub 1 Septic Tank& Pit
Clothes Washer Shower
Dishwasher I Shower Pan I
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 2-
Hose Bibs I Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory d- Water Heater I
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 ,
Driu.5ng Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Trey Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
Sewer Replacement ❑ Back Flow Preventer Grease Interceptor(Trap) gallons(Requires 3 sere of plana)
Lawn Sprinkler System-Number of Heads Well ••
** S1RWD Well Completion Form. Completed ran tobe submitted to the Building Department for final inspection.**
Other
Permit becomes void if work does not commence within a six nwnth period or work is suspended or abandoned for six months.I hereby certify that 1 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 nor The permit does not give authority to violate the previsions of any other state or local law regulation construction or the performance of construction.
Property Owners Name/' J�,I I!. n SJe 0-,� �$ Phone Number
Plumbing Coupwany Cannorn II IV orOfficePhonegaR--)"-LiS95 Fax9o'i-SSI-m`FIL
('.. Address: 171 E Cbokh 2- City J_a k_-canvdle State FL Zip 3.a ao 2-
License Holder(Print): 0),,-I Cr2 n rl 04 _ _ _- State Certification/Registration# C FC )
Notarized Signature of License Holder
LESLIE DALE Sworn and subscribed before me this l� day of
} fgmrtissiai%FF 11437E
y r Expires July 23,2018
.,0+ wa.+s�,.r..awawamn Signature of Notary Public
r` ATLANTIC BEACH
r PERMIT RECEIPT
September 13,
2016
PERMIT DESCRIPTION: install new tub, hose bib,sink,2 lavatories,shower pan,2 toilets,water heater
PERMIT NUMBER: 16-PLBG-2045
ADDRESS: 1303 OCEAN BLVD
OWNER:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $70.00
Trade Permit Base Fee $55.00
Totals: $129.00
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