350 3rd St pool house plbg permit ?SI ,
CITY OF ATLANTIC BEACH
r 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-2765
Job Type: PLUMBING ONLY
Description: install lavatory, shower, & toilet for detached pool house
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 CIA WALLACE SCOTT WOOD
Phone: -
FEES:
Plumbing Fixtures $0.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $59.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
U
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845 Q0o1 I to pt,aryl-
JOB ADDRESS: 3S 3 f SA . C d Lk (,W 'AW PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPEoFF)xwRE QTY TYPE oFFvrmRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet T__
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPEOFFIXTURE QTY TYPEOFFixTURE 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 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
**SJRWD Well Completion Farm. 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 heaby 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
or not The permit does not give authority to violate the provisions of any other state or local law regulation conswction or the performance of construction.
Property Owners Namefi-�4• 13� nT��c/�-+'e /7�+✓�y7 Phone Number
O/ (P lu
Plumbing Company C W 6dOd �r0.'�r Office Phone 7k7`�60Y FFaax
Co.Address: .3 JM/.k S.:- City T X State/ Zip 3 " �P
License Holder(Print): v✓• S4,17-7 ",01901 .State C)ert�i_fica/fi5n/Registration#9!51L'6Ur;Vy7
N3JNIFEft TOM�n.
e older / �- '--✓G�r��
M cowEX s s m OGzr,� Before me this a' day of A tLP-M�{ 20 I
''••„'„.•a'`il BmMa Ma Ndary>+aEUMamrlMt ..
Signature of Notary Public