1735 Beach Ave plbg permit Sim-LJri,. .
CITY OF ATLANTIC BEACH
r
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-1979
Job Type: PLUMBING ONLY
Desaiptlon: PLUMBING - 19 FIXTURES
Estimated Value: $3,500.00
Issue Date: 8/31/2016
Expiration Date: 2/27/2017
PROPERTY ADDRESS:
Address: 1735 BEACH AVE
RE Number: 169668-0000
PROPERTY OWNER:
Name: LANE III, EDWARD W
Address: 1735 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: J WHITEHEAD PLUMBING INC
,CFC1427565
Address: 12811 BEAUBIEN RD JASON WHITEHEAD
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $133.00
Trade Permit Base Fee $55.00
Total Payments: $192.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233 Q r p Q
Ph(904)247-5826 Fax (904)247-5845 1&—PLE)G"(
JOB ADDRESS: 1 35 '3001W /' ""� PERMTT#
NEW OR REPLACEMENT INSTALLATION: Project Value$____.
TYPEOFFIxTORE QTY TYPE oFFLYTURE QTY
Bathtub Z Septic Tank&Pit
Clothes Washer Shower '7
Dishwasher T Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal 1n
Kitchen Sink Vacuum Breakers N
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPEoFFIXTURE 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 ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
t7 Lawn Sprinkler System-Number of Heads ❑ Well *•
**SIRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
t7 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 my other state or local law regulation construction or the pe nnan of construction.
Property Owners N e L n� Phone Numb��er////���� -05
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Plumbing Company wn1> A1s? UA�D Office Phone(;
Co.Address: � City I \` State Zip
License Holder(Print): State Certification/Registration#— V�
Notarized Signature of License Holder
efore me this�__day' f 2
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MY DOMMISSION a FF a2A.1NV
T i tore of Notary Public
E%PIBES Qtober a,2019 �
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