1580 Beach Ave plbg permit CITY OF ATLANTIC BEACH
r 800 SEMINOLE ROAD
y ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
]OB INFORMATION:
Job ID: 16-PLBG-2560
Job Type: PLUMBING ONLY
Description: PLUMBING - 17 FIXTURES
Estimated Value:
Issue Date: 11/14/2016
Expiration Date: 5/13/2017
PROPERTY ADDRESS:
Address: 1580 BEACH AVE
RE Number: 171875-0000
PROPERTY OWNER:
Name: KOHL, MARK
Address: 1580 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: TURNER PLUMBING CO.
,CFCO29746
Address: 1903 HENDRICKS AVE QA WORTH B TURNER
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $119.00
Trade Permit Base Fee $55.00
Total Payments: $178.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CUFF OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 k/ (
Ph(904)247-5826 Fax(904)247-5845 wo T tDll �p
JOB ADDREss: /,� &e,41- //K 4✓-e, . PERMIT# AR-
vroz_
NEW OR REPLACEMENT INSTALLATION: Project Value$ -
TYPEoFFIXTURE QTY TYPE oFFWuRE QTY
Bathtub 1 Septic Tank&Pit
Clothes Washer / Shower /
Dishwasher i Shower Pan t
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs L Urinal
Kitchen Sink / Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE of FIXTURE Q 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 C Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads 0 Well **
**SIRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
0 Other
it b s void if work does not commence within a six month period or work is suspended or abandoned for six months.I hereby certify that 1 have read
k:. ' and know the same to be tro,and correct. All provisions of laws and ordinances governing this work will be complied with whether specked
m. 't does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
P ers Name Yyl a Phone Number
PImP Yan t u �-r f�rn.�.hi;w �� . Office Phone 3 `rV-7"I4 Fax39G -7o-4(e
Co 9°3 yeti-Qr,.�C) F1"�— city T c ks>A-lll, state Ft zip 3L7a7
I _
Li c er(Print): 0or'+kIj.i r,.rn�i 22 State Certification/Registration# eft 0'19 -74(P
Not ed Si ature ojlrcense Holder
J .
f" - tolacwotEsv �, Before me this day of
�i=�'�"��•p nttcotaassroh
1XI Signature of Notary Public