325 Country Club Ln house plbg permit CITY OF ATLANTIC BEACH
...Sj 800 SENIINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
]OBINFORMATION:
Job ID: 16-PLBG-2328
Job Type: PLUMBING ONLY
Description: 28 Fixtures
Estimated Value:
Issue Date: 10/17/2016
Expiration Date: 4/15/2017 _
PROPERTY ADDRESS:
Address: 325 COUNTRY CLUB LN
RE Number. 171962-0000
PROPERTY OWNER:
Name: GROVER JR, WILLIAM HOWE
Address: 325 COUNTRY CLUB LN
GENERAL CONTRACTOR INFORMATION:
Name: CROCKETT PLUMBING COMPANY
,CFC057741
Address: 11331 PENDER RAULERSON RD QA WILLIAM JOHN
CROCKETT, JR
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
�+ P1CI h.(�904)(2'47--5826 Fax(904)247-5845
JOB ADDRESS: 3 a�( '° U c17 vU wb U'V-0 — PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value S
TYPE OFFLYWRE QTY TYPE oFFIXTURE QTY
Bathtub _.3 Septic Tank&Pit
Clothes Washer I Shower Z
Dishwasher _� Shower Pan _L
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet L
Hose Bibs Z Urinal
Kitchen Sink Vacuum Breakers
Laundry Trey / Water Connected Appliances /
Lavatory Water Heater _X
Other Fixtures Water Treating System
RE-PIPE:
TYPE OF FIXTURE 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 seta of plana)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
**SIRWD Well Completion Form. Completed form to be submitted to the Bui ding 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.1 hereby certify that I have read
Nis application and know the same to be tine and correct. All provisions of laws and ordinances governing this work will be complied with whethtt specified
or not. The permit does not give authority
��to�� performanceviolate the Provisions of my other state or local law regulation oonstrualon or the performance of construction.
Property Owners Name C� Uf l— /Phone Number
Plumbing Compan}d /D a6l�- t,014 'I &nVOffice PhonC�3'/dD/p F
Co.Address:V'� Cite Stat' Zia
License Holder(Print): State Certification/Registration 00577`'F/
Notarized Signature of License Holder
fC >1 C
6.23 - 930-73 Swom and suscribed beforem ' / � da 20 /6
-)yL —o WONNE CALVERItY
Signature of Notary Publi ?/� '� krr_coNrysyoµyFr-g
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