2393 Ocean Breeze Ct plbg permit CITY OF ATLANTIC BEACH
j ) 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
r it U�
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
30BINFORMATION:
Job ID: 16-PLBG-2780
Job Type: PLUMBING ONLY
Description: PLUMBING -WATER HEATER
Estimated Value:
Issue Date: 12/13/2016
Expiration Date: 6/11/2017
PROPERTY ADDRESS:
Address: 2393 OCEAN BREEZE CT
RE Number: 168908-8230
PROPERTY OWNER:
Name: HANSEN, KIRK& BONNIE,
Address: 2393 OCEAN BREEZE CT
GENERAL CONTRACTOR INFORMATION:
Name: COOKS EAST COAST PLUMBING
,CFC044206
Address: 4850 OUTRIGGER DR QA EDGAR COOK, JR
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $7.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845 f (_P 1 'Z7(5
JOBADDREss: �;Z 3c( 3 (1c FAry Grt EEZE Court- PERMIT#
31. 133
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPEOFFIXTURE QTY TYPEOFFDrruRE 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
RE-PIPE:
TYPE oFFLYTORE QTY TrPEOFFIXTURE 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 ❑ Back Flow Preventer ❑ Grease Interceptor(Tmp) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
**SJRWD 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 certifythal l 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 smte or local law regulation construction or the performance of construction.
Property Owners Name K( r K ft t,J 156 N r I G A r� S c ti Phone Number a`1 ( —7 g-SC?
Plumbing Company CDok' CCAS`r COAct -' P S)fficePhone90f-G"1D1t3YFax
Co.Address: 4 $5t) A t 1 +R i4q E N p r _ city TT-,4� State FG, Zip 3
License Holder(Print): _ r-- (f State Cert egistmtion# C F C01.1 LID Q(
Notarized Si er t
•"""y'+, TONI GINC4ESPniGEa
:���'t MYCGMMIGGIl1NAFF 524351 efOre methls � daJ 20
+a'�i E%PIFES'.Ocloler 6.2G19
.rat;,ng: a�,erary wan 9�ca uwz.m. ignature of Notary Public