43 SARATOGA CIR - PLUMBING j �Jyr
# • S, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
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-3519
Job Type: PLUMBING ONLY
Description: PLUMBING - 12 FIXTURES
Estimated Value:
Issue Date: 3/17/2017
Expiration Date: 9/13/2017
PROPERTY ADDRESS:
Address: 43 N SARATOGA CIR
RE Number: 171786-0000
PROPERTY OWNER:
Name: ETTLINGER, JUDITH C
Address: 43 N SARATOGA CIR
GENERAL CONTRACTOR INFORMATION:
Name: ROTO ROOTER SERVICES
, CFC 057629
Address: 2028 W 21ST ST QA ROBERT VINCENT FARR
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $84.00
Trade Permit Base Fee $55.00
Total Payments: $143.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 ) 7 -PCB -3 S ( (-)
JOB ADDRESS: q c ,e,0,4-0.9 q C'‘v"c-, C N /Q--}-(cuvtA-C c Z6a0{t1c4 PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
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 .
1 RE-PIPE: `--1/
TYPE OP FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub I Septic Tank&Pit
Clothes Washer 1471 Shower J_
Dishwasher _1_ Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet a,
Hose Bibs R_ Urinal
Kitchen Sink J. Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory a. Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS: i}oA-" &. C 2 r- oze. civlAy
D Sewer Replacement . Back Flow Preventer 0 Grease Interceptor (Trap) gallons (Requires 3 sets of plans
In Lawn Sprinkler System-Number of Heads o Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.*'
0 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 rea
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 construction or the performance of construction.
Property Owners Name '>,,d r\-"n 544 \►n 3 e,+r )( 2-19c 9 Phone Number 85p-501.33 as
Plumbing CompanyR o4 c> R oo-�'P—+' Office Phone1c.4-394-13 a•( Fax 6104-354-4i;•,.5',5
Co. Address: a1 U a...s we511- As f-5-}r - Ci - ' it;1( State 5 Zip 09
License Holder(Print): Y1(��,r�b4 c r1vNeAi t State Certification/Registration# CX(. 0516 :1Notarized Signature of License Holder tA ) .AA,.j _,
Sworn and subscribed before me this /'Y day of /( 1A/e ?p 20 ("i'
Signature of Notary Public �,e.�� ;x;'11"tytiz ERI=N S.JUNGKLAUS
p. ., Ctnnntisolon 9 rP 179297
'41;i4 Expires November 25,2018\ /S ( ( , R ,\2Cc? uC) . J c_f , @ c„ `} 4V
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CITY800 SEMINOLE RD CH
ATLANTIC BEAC,FL 32233
11:23:23
03+11!2011 CREDIT CARD
_ MC SALE ��XB02B
Cards 2
BEACH 5Ed#'. 323
BOO SEMINOLE ROD FL 32233 2
?NONE (304) 247 5825 INVOICE 005611
PHONE 1 dual
•13 AM Approval Code:
Cashier Id: : 3/1"d2017 1i:23 bpd Online
Receipt Date: : O -72 Entry
RJob I t Number: 03-?2558 12 FIXTUR Manual Receipt
PLUMBING - Tax 1'
Job ID: 117-PLB-3519 - 12 FIXTUR at Wil M
PLUMBING -
Job ID: 17-PLBG-3519 ` 12 FIXTUR Card Code'
PLUMBING - �lp�'M
Job ID: 17-PLBG-3519 PLUMBING - 12 FIXTUR p •t W
Job ID: 17-PLBG-3519 - Still f1MOU
$143.00 Cash $143.00
Amount Due:ormation:
Tender
Tender Am unt C$143.00
Tender
Change Due: $0.00 CUSTOMER COPY