325 Country Club Ln garage plbg permit CITY OF ATLANTIC BEACH
j c) 800 SEMINOLE ROAD
J ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
r i3 y
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
70B INFORMATION:
Job ID: 16-PLBG-2327
Job Type: PLUMBING ONLY
Description: 1 bathtub, 1 clothes washer, 1 dishwasher, 2 hose bibs, 1
kitchen sink, 2 lavatories, 2 toilets, 1 water connected appliance.
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
,CFCOS7741
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 $77.00
Trade Permit Base Fee $55.00
Total Payments: $136.00
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
JOB ADDRESS: 3a S CP tA�G 1-1-L Cr�n� PERMIT# �
NEW OR REPLACEMENT INSTALLATION: Project Value S
TYPE oFFixTURE 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 1
Hose Bibs L Urinal
Kitchen Sink �_ Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory A Water Hester
Other Fixtures Water Treating System
RE-PIPE:
TYPE OFFixTuRE QTY TYPEOFFMuRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Tbree 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 [1Well
**STRWD Well Completion Form. Completeddormtoto be submitted to the Building Department for fund 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
m not 'Me permit does not give authority to violate the provisions ofany other sone or local law regulation construction or the performance of construction.
Property Owners Name
}} � � �� II'e/' Phone Number
Plumbing Company(;/WX% Office Phone Fax
Co.Address:4/5 City Stat �(03
Zip✓ .
License Holder(Print): Mary-) Cl�lxg 'fication/Regishation;4��®s7�d��
Notarized Signature of License Holder
F1 # C 612 3 -9 30 9J2YG o Swom and sub"d before me us '� &
:�"' 0 EMyMMqJSE
Signature of Notary Publictaas: aFBM7
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