1249 BEACH AVE - PLUMBING >' 1 .V \S, CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
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ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-2874
Job Type: PLUMBING ONLY
Description: PLUMBING GARAGE- 18 FIXTURES
Estimated Value:
Issue Date: 12/27/2016
Expiration Date_: _ 6/25/2017
PROPERTY ADDRESS:
Address: 1249 BEACH AVE
RE Number: 170292-0000
PROPERTY OWNER:
Name: Boeneke, Demory
Address: 7093 Ox Bow RD
GENERAL CONTRACTOR INFORMATION:
Name: TDG PLUMBING
, CFC1427062
Address: 4426 LOYS DR QA TRAVIS DALE GAINEY
Phone: 904-545-7341
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $126.00
Trade Permit Base Fee $55.00
Total Payments: $185.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
•
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-58451 Cj_ PU3 _ Z E574
JOB ADDRESS: laLict'" 4/ I�ci\CI-f. PERMIT#
C PAGE
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub __ Septic Tank&Pit
Clothes Washer _A_ Shower _Z__
Dishwasher -t--- Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet w
Hose Bibs ___ Urinal
Kitchen Sink liVacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory - Water Heater 1
Other Fixtures \ Water Treating System
RE-PIPE:
TYPE OF FIXTURE QTS' 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:
o Sewer Replacement ❑ Back Flow Preventer 0 Grease Interceptor (Trap) 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 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 construction or the performance of construction.
Property Owners Name e mo i oen P K Q Phone Number
Plumbing Company-7-'1C) a CP 1...i.,.\p;4v%�� n C Office Phone S S Th 4 Fax.vt..`i"t ts1
Co. Address: Li k2 kr. Loi S Z City . Act State FI Zip 322M S`
License Holder(Print): l (Z.A., Z 3 0 e,Al./142 State Certification/Registration# e fC^t 7c c.
Notarized Si nature of License H.oldet �) , I
;yµ'.ei ,; TONIGINDLESPERGER Before me this 7da �' t...14 0 ` (�
y; La, ;., MY COMMISSION#FF 924951 /
s•;�5g- EXPIRES:October 6,2019 '-OM
'��gn°`�' Bonded ThruNoaryPublic Underwrt?ra Signature of Notary Public _, N