350 3rd St house plbg permit 'rS rlr+
n CITY OF ATLANTIC BEACH
.f 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-2761
Job Type: PLUMBING ONLY
Description: install 24 fixtures
Estimated Value:
Issue Date: 12/12/2016
Expiration Date: 6/10/2017
PROPERTY ADDRESS:
Address: 350 3RD ST
RE Number: 169784-0000
PROPERTY OWNER:
Name: Henderson, Jacqueline
Address: 350 3Rd ST
GENERAL CONTRACTOR INFORMATION:
Name: C W WOOD PLUMBING
Wallace Scott Wood,CFC057097
Address: 1328 ROMNEY ST QA WALLACE SCOTT WOOD
Phone: -
FEES:
Plumbing Fixtures $168.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $227.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ai
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904J 247-5826 Fax(904)247-5845 b - PL 661- a-+W
Jos ADDRESS: 3S0 3 S�cmc —' PERAffr#
NEW OR REPLACEMENT INSTALLATION: Project Value$ -
TYFEoFFixTuRE QTY TYPEOFFLYTORE QTY
Bathtub 2 Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet (/
Hose Bibs . 3 Urinal
Kitchen Sink T� Vacuum Breakers
Laundry Tmy —>— Water Connected Appliances
Lavatory Water Heater [
Other Fixtures Water Treating System
RE-PIPE:
TYPE oFF1xTURE QTY TYPEOFF1x7'uRE 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 Tmy Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement 0 Back Flow Provender ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
o Lavm Sprinkler System-Number of Heads ❑ Well **
**&IRWD 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 certifythst I have read
this application and know the same to be true and cones[. 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 regal v e. or the performance of construction.
Property Owners Name A�Gi]ArC/ /solinub���/hG���� PhoneNumber
Plumbing Company �- �. Wovr/ (/"1Un�iis/ Office Phone 7gV-66061 Fax
Co.Address: l .3 2X AOI"1I a y �'Y n City T'YX State Zip 3L2,✓
/� / ,
License Holder(Print): (N� Sl�7 / (/1/vv tto Ce i raf�n_/B�epitration lt�i 1967
N tnr' Ider
JENNJf JONN5IDN
""a t NvcoamlS31ON0ooMm Before me this_J�day of OU Qx b a✓ 20 (
14
E%PM5,news 27,3030
,�^.x% I^ni No°'a°"°k°ntlixiYM` Signature of Notary Public