1519 Jordan St plbg permit CITY OF ATLANTIC BEACH
"J 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
s INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-PLBG-3220
.Job Type: PLUMBING ONLY
Description: install 11 fixtures
Estimated Value:
Issue Date: 2/9/2017
Expiration Date: 8/8/2017
PROPERTY ADDRESS:
Address: 1519 JORDAN ST
RE Number: 172297-0000
PROPERTY OWNER:
Name: BEACHES HABITAT FOR HUMANITY
Address: 797 MAYPORT RD
GENERAL CONTRACTOR INFORMATION:
Name: ADVANTAGE PLUMBING
Gregory K. Gauss,CFC1425959
Address: 880 MAYPORT RD QA GREG GAUSE
Phone: - -
FEES:
Plumbing Fixtures $77.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $136.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CHT OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
II
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233 PL-es(-I-"3�Qb
A/ Ph(904)247-5826 Fax(904) 247-5845
JOB ADDRESS: A* ,Vi a! PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE of FIXTORE QTY TYPE of FixruRE QTY
Bathtub Septic Tank&Pit
Clothes Washer T Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs ;Z,— Urinal
Kitchen Sink Vacuum Breakers
Laundry Troy Water Connected Appliances
Lavatory Water Heater T
Other Fixtures Water Treating System
RE-PIPE:
TYPE oFFIXTORE QTY TYPE ot,FixTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwwber Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tiny 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 ««
**SIRWD 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.1 hereby certify that I have read
this application and know the same to be tme and correct. All provisions of laws and ordinances governing ibis work will be complied with whether specified
or not The permit does not give authority to violate the ppmj isions of my
yy-other state or local law regulation construction or the performance of constmction.
Property Owners Name 9A� X,ES it/W17W-
17/W/ Phone Number
Plumbing Company .�e�,M✓yt 79�7� �Y�7�'ibr Office Ph meo?Y7" ,0dV f FavWV
Co. Address: a /'/J P City State a Zip 3,-233
License Holder(Print): � State Certification/Registration# rRAK ?
older
RyY,�,'•y'+Y JENNIFER rob
NSTON
f .l Nvco"Issl ttl' 2WBefore me this 91ndayof 20 1�
�, p ExPIREs:atman.mzo
g,,,;° Iww.a "<nnw+muas.^.nw Signature of Notary Publico-, \ ��