315 12th St plbg permit 'rt I`1�yT1
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
JOBINFORMATION:
Job ID: 16-PLBG-2310
Job Type: PLUMBING ONLY
Description: PLUMBING - 7 FIXTURES
Estimated Value:
Issue Date: 10/14/2016
Expiration Date: 4/12/2017
PROPERTY ADDRESS:
Address: 315 12TH ST
RE Number: 171910-0015
PROPERTY OWNER:
Name: Marcotte, Kyle
Address:
GENERAL CONTRACTOR INFORMATION:
Name: TDG PLUMBING
,CFC1427062
Address: 4426 LOYS DR QA TRAVIS DALE GAINEY
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Plumbing Fixtures $49.00
Total Payments: $108.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax (904)247-5845 I (Sv-P L 6G _Z 3 10
JOB ADDRESS: ` S �2T� 5 PERMIT# y
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE oFFIXTuRE 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
RE-PIPE:
TYPE oFF1XTORE QTY TYPE oFFIXTURE 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)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
**&IRWD Well Completion Form. Completed forst 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 ofwns mctim.
Property Owners Name T 'MA C cAe- Phone Number
Plumbing Company�� tnLt..,ran:/� Office PhoneS' f 7'J4�� Fax1S •�$6�B
Co. Address: 1-1t-121. 0Q- City-,T'A'f StateFL_Zip 2 4l,
License Holder(Print) : State Certification/Registration#CSC-lV2'7rx.2
Notarized Signature of License e
EK:
ell
s est fore me this��dayof � 20 I:occal,I'llaysr"u` ature of Notary Public Iv