631 Beach Ave plbg permit �IIyLIrrl
CITY OF ATLANTIC BEACH
sI 800 SEMINOLE ROAD
!J _� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
]OBINFORMATION:
JobrD: 16-PLBG-2896
Job Type: PLUMBING ONLY
Description: PLUMBING - 5 FIXTURES
Estimated Value:
Issue Date: 12/29/2016
Expiration Date: 6/27/2017
PROPERTY ADDRESS:
Address: 631 BEACH AVE
RE Number: 170113-0000
PROPERTY OWNER:
Name: HUDSON, '
Address:
GENERAL CONTRACTOR INFORMATION:
Name: CUSTOM PLUMBING AND TILE
, CFC1427389
Address: 2742 SETTLEMENT DR QA THOMAS MICHAEL
BLACKBURN
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $35.00
Trade Permit Base Fee $55.00
Total Payments: $94.00
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: zwexl 4tlp, PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Values
TYPE oFFLYTORE QTY TYPEoFF&TURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher �_ Shower Pan
ki
Drinng Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE oFFIXTuRE QTF 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 o Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
**S,RWD Well Completion Form. Completed form 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 cernfythat 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 arty other state or local law regulation constmction or the performance of construction.
Property Owners Name// 11"WA -r Phone Number
Plumbing Company 14aS ZOM,/ P14MIKb.iu r Ti!/ Office Phone jF6,U'F9s"I Fax
Co.Address: e77�R ,rr,,4 44, .r, L 0,(- City 6�-k Stal,69 Zip? 2-L2L
License Holder(Print): Z[A,K ,R/ State Certification/Registration# CFC/Si 27g8
rimd.Vgnmare of L' Holde
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p ': nn�amnis o�veA szasst Before me this_-�day o 00
EgaF a,E�PrREOcpbe:6
Signature of Notary Public