135 Pine St 17-PLBG-3153 plbg permit CITY OF ATLANTIC BEACH
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 INFORMA71ON:
Job ID: 17-PLBG-3153
Job Type: PLUMBING ONLY
Description: PLUMBING - REPLACE WATER SERVICE
Estimated Value: $1,750.00
Issue Date: 2/1/2017
Expiration Date: 7/31/2017
PROPERTY ADDRESS:
Address: 135 PINE ST
RE Number: 170636-0100
PROPERTY OWNER:
Name: SHADDEN TRUST, E BLOCKER
Address: 135 PINE ST 135 PINE ST
GENERAL CONTRACTOR INFORMATION:
Name: DAVID GRAY PLUMBING INC.
David Fred Gray,CFCO22586
Address: 6491 S POWERS AVE CIA DAVID FRED GRAY
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 �RIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904)247-5845 1'7- PL66 -3 IS5
JOB ADDRESS',& linc , 2aa Mt-A,-2& 1�e�4 6, 3)��31iktzmn#
NEW OR REPLACEMENT INSTALLATION: Project Value r7sD
TYPE OF FixTuRE QTY TYPEoFFIxTURE 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 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:
ci Sewer Replacement D Back Flow Preventer Ei Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
Ei Lawn Sprinkler System-Number of Heads Ei Well
**SJRWD Well Completion Form. Completed form Fo be submitted to the Building Department for final inspection."
dOthe, A-eOnre, wa4-ev- s-&-oice,
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.I hembycenify that I have mad
this application and know[be sarne to be(me and connet. Ali provisions of laws and ordinances governing this work will be complied with whether specified
ornot. The permit does not give authort,to violate the provisions ofany other state or local law regulation constractimi mthe performance ofconstraction.
Property Owners Name t�L!Xs f
2kL11f1&) Phone Number 9�1-24&�
Plumbing Comp I '.&A C�ezi.64 101i I r'0in(4 Office Phone 99-7M-77,1 I Faxq0L4-7?N-5qZr
Co. Address4�1 eck'va�' Ail City StatdP
� _k__ _L Zip
License Holder(Print): State Certification/Registration# 0.4-�Cox?'5
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