1137 Violet St plbg permitCITY 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 INFORMATION:
Job ID:
17-PLBG-3474
Job Type:
PLUMBING ONLY
Description:
install 15 fixtures
Estimated Value:
$6,085.00
Issue Date:
3/14/2017
Expiration Date:
9/10/2017
PROPERTY ADDRESS:
Address:
1137 VIOLET ST
PROPERTY OWNER:
Name: PATRICK GLEBER INC.
GENERAL CONTRACTOR INFORMATION:
Name: GREEN BUILT CONSTRUCTION & DEVELOPMENT
Michael Dean Denard, CFC037182
Address: P O BOX 54007 JKVL FL 32245
FEES:
Plumbing Fixtures $105.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $164.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
'qe�s� � U
PLUMBING PERMIT APPLICATION -
CITY
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach. FL }223}
Ph (9044()247-5826 Fax (904) 247-5845 �_ Pl.C3��_ 344y
JoB ADDRESS: ��_5� Vib b-+_ ZTr PERMI'TH -F/loll-''`'
RE -PIPE:
REPLACEMENT (NSTALLATION:
TYPE OF FIXTURE
Bathtub
Clothes Washer
Dishwasher
Drinking Fountain
Floor Dram
Floor Sink
Hose Bibs
Kitchen Sink
Laundry Tray
Lavatory
Other Fixtures IGe mama f.
TYPE of FIXTURE
Bathtub
Clothes Washer
Dishwasher
Drinking Fountain
Floor Drain
Floor Sink
Bose Bibs
Kitchen Sink
Laundry Tray
Lavatory
Other Fixtures
QTY
t
WAN
QTr
Project Valdes
TYPE or FIXTURE Q7'Y
Se tic nk & Pit
ower
ower Pan
lop m
Three Compartment Sink
Toilet
Urinal
Vacuum Breakers
Water Connected Appliances
Water Heater
Water Treating System
TYPE or FIXTURE QTY
Septic Tank & Pit
Shower
Shower Pan
Slop Sink
Three Compartment Sink
_ Toilet
Urinal -----
--
Vacuum Breakers
Water Connected Appliances _
Water Heater _
Water -1realing System
MISCELLANEOUS:
- Sewer Replacement Back Flow Preventcr :: Grease Interceptor (I•rap) _ _ _ gallons (Requires S sets or plana)
Lawn Sprinkler System-Numberot'heads _ Well
** S7RWU Well Completion Fornr. Completed Form to be submitted to the Building Department for final inspection.**
epther
Persia becranes void ifw.& dues not wnunenec widtia a sis nwmh period ar work is suntwtWd or aAvWoad liv si. mm.. Ws. 1 hadhv cenik Ilot I have rend
this application .md know the unm to b vue and nand. All pmvisionn of hews and ordinance<sonminr.Ih6word rsill he mrmPlid..ith-Wsh-r spvellieJ
ur not. ILe permit Jrws not Bice auth�ritymviolate the pmviskxls ol'am other emtt local low mgulation aaoi.minn nr the perliatnane..I''.n.trtwl uyn-.7
> • _4ki _ UKI!(/l' �,�'i�f fi nVin Phone Number 7fiY"�'II ✓•� /
Properly Owners Name �/ J� J.{,
Plumbing Company �t'P-1l ;JU !'F ¢bKV s l�1 G Office Phonc9a/-G.>K3�Fn>�V_ %1S -k> I
co. Address: e r cilykhim�le Smte zip
License Holder(Print): /I1�h ' 17 r�- _ Slate Ceilificalion/Itcgistralion.401-6(ti?1FZ
Notarized Signansre of License Holder
Sworn and xuhnn IheJ +� tt _ I / Q/CGe-GST 1 20tz
. owe pAT+�19
Signature,��i11F
rrer
CITY OFAr(ANT3C BEACH
800 SEMlND(FRD
#311412017ATATICBEAC, FL 3243
Cf1T CARD 11:99:92
VISA se
5
320
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009992
Maul
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$0,00
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Cumt R COPY
CITY OF ATLANTIC BEACH
DOD SEMINOLE ROAD 32233
ATLANTIC BEACH. FL
PHG✓E (904) 247-5826
Cashier Id: atlbcld\atlbbia
Receipt Date: 3/05 6711:45:57 AM
Receipt Number:
ddb ID: 17-PLEG-3474 - install 15 fixtures
J,b ID: 17-ALB6-3474 - install 15 fixtures
Job ID: 17-PLBG-3474 - install 15 fixtures
,bb ID: 17-PLBG-3474 - install 15 fixtures
Amount Due: $164.00
Tender Informatimo:Tender TYPel CE
Cash 4164.00
Tender AmountuS169.00
Change Due: 30.00