1755 Beach Ave plbg permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
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INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL SY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-PLBG-3309
Job Type: PLUMBING ONLY
Description: install 20 fixtures
Estimated Value:
Issue Date: 2/22/2017
Expiration Date: 8/21/2017
PROPERTY ADDRESS:
Address: 1755 BEACH AVE
RE Number: 169672-0000
PROPERTY OWNER:
Name: Swanson, Jeffrey D
Address: 1755 Beach AVE
GENERAL CONTRACTOR INFORMATION:
Name: COGBURN AND WAKEFIELD PLBG
John Cogbum,CFC1428140
Address: 5900 TOWNSEND BLVD APT 522 QA JOHN COGBURN
Phone: -
FEES:
Plumbing Fixtures $140.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $199.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826^ Fax (904)247-5845
JOB ADDRESS: I—I7 SS- B� TMc . PERMIT# ko- kW-213(.
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE of FIXTURE QTY TYPEOFFIXTuRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower I
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 oFFIXTURE 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 ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ lawn Sprinkler System-Number of Heads ❑ Well **
**SJR WD Well Completion Form. Completed form to be submitted to the Building Department for fmal inspection.**
❑ Other
Permit becomes void if work does not commence within..is month period or work is suspended or abandoned for six months.l hereby certify that I have read
this application and know the same to be hue and comet[. All previsions 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 Sr.',A.rSorJ f Phone Number 90N -2d/-631,0
Plumbing Company u L,P - ,LJ P6,4ftl Office Phone 903?Y•J Fax
Co.Address: 1809 /. .o �//+� City --TA-k State�zip 32Z 16
License Holder(Print): o C'- b t Certification/Registration tl CFC(`(LFIy0
Notarized Signature of License Holder
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