1433 Beach Ave plbg permit A
CITY OF ATLANTIC BEACH
rJ 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 INFORMATION:
Job ID: 17-PLBG-3308
Job Type: PLUMBING ONLY
Description: install 9 fixtures
Estimated Value:
Issue Date: 2/22/2017
Expiration Date: 8/21/2017
PROPERTY ADDRESS:
Address: 1433 BEACH AVE
RE Number: 170303-0000
PROPERTY OWNER:
Name: MORRIS, MARY UIBLE
Address: 1433 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: COGBURN AND WAKEFIELD PLBG
John Cogburrl,CFC1428140
Address: 5900 TOWNSEND BLVD APT 522 QA JOHN COGBURN
Phone: -
FEES:
Plumbing Fixtures $63.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $122.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH l J
800 Seminole Rd Atlantic Beach, FL 32233
' `
Ph(904)2,t347-5826 Fax (904)247-5845 ��- PL6&I- 3 O�
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JOB ADDRESS: I f 33 Be"V.e (X'-'e PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPEOFFixTORE QTY TYPE OF FIXTURE QTY
Bathtub 2. Septic Tank&Pit
Clothes Washer Shower 1
Dishwasher _ I Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink 12— Vacuum Breakers
Laundry Tray Water Connected Appliances e2.
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE OF FIXTURE QTY TYPEOFFIXTORE 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(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 goveming 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 contraction.
Property Owners Name IM.OR.1L i AS g t j I I Phone Number goy -241-pT 2-o
Plumbing Company bjl, r"41"(1 OUA,13
OfficePhone 90Y-"Y Jf0 Fax
Co. Address: 0 twj. I.✓ City 5A-4 State F1- Zip 32210
License Holder(Print): ov' A- a Certification/Registration# CFC 1�4281�J
Notarized Signature of License Holder
• ;.'%.,. J�lfEndoMNsroN Sworn and s scribed bettor rc this as day of FP—u�k(Ny 20«
I M EXPIRES,
XPIRE ,ocabs GG WX
�. E%PWES:OMaer 21,30]0 Signature f Notary Pub '• \`\V(I�T_I^W, -LAYnVT+_
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