63 ROBERT ST - PLUMBING J \s�
CITY OF ATLANTIC BEACH
;J - 800 SEMINOLE ROAD
j ;r 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: 17-PLBG-3397
Job Type: PLUMBING ONLY
Description: install 10 fixtures
Estimated Value:
Issue Date: 3/2/2017
Expiration Date: 8/29/2017
PROPERTY ADDRESS:
Address: 63 ROBERT ST
RE Number: 172229-0020
PROPERTY OWNER:
Name: TURNER, CLARA MAE
Address: 63 ROBERT ST
GENERAL CONTRACTOR INFORMATION:
Name: ADVANTAGE PLUMBING
Gregory K. Gause, CFC1425959
Address: 880 MAYPORT RD QA GREG GAUSE
Phone: - -
FEES:
Plumbing Fixtures $70.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $129.00
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PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION `D)
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845 il-- PLeCi_ 33 q
JOB ADDRESS: ��,
to S 'S ' - PERMIT# /7 -Sf '/
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 1 Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet X
Hose Bibs I Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory T Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE OF FIXTURE QTY 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:
❑ Sewer Replacement 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads 0 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 construc_tion or the performance of construction.
Property Owners Name g446/1E c /7f/.3 i// 9/Pi7 /P Phone.
nye Number
Plumbing Company /iO4/4/4719 to AolZ/Aj Office Phone,77' 9gy5 Fax
Co. Address: gav v17>(y.o,ej // City
/ State Zip
License Holder(Print): / " "(1 Zr. / Stat C ification/Registration# (K//yam 9.11
Notarized Signature of License older .ir ie...„.
4;r '•'••,, JENNIFER JOHNSTON
Before me this ay of M ar�lrl 20 1
°ZtYl
• MY COMMISSION 0 GG 042914 —
`',' a,_ :,4 t° EXPIRES:October 27,2020 '
'•.':Fo N:dh:.?;to. Bonded'Mu Notary Publ�c Undermiters Signature of Notary Public '.. \_1 .str.!,
4