193 BEACH AVE #4 - PLUMBING r J_
(3' \1, CITY OF ATLANTIC BEACH
. f f
? 800 SEMINOLE ROAD
j 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-3717
Job Type: PLUMBING ONLY
Description: PLUMBING - 3 FIXTURES
Estimated Value: $1,500.00
Issue Date: 4/10/2017
Expiration Date: 10/7/2017
PROPERTY ADDRESS:
Address: 193 BEACH AVE 4
RE Number: None
PROPERTY OWNER:
Name: Travis, Russell L
Address:
GENERAL CONTRACTOR INFORMATION:
Name: LETTOW PLUMBING
, CFC 1428068
Address: 3637 Cedar Crest DR
Phone: 9.04-708-1999
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $21 .00
Trade Permit Base Fee $55.00
Total Payments: $80.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845 r i -- L - 37 i 7
/ or PERMIT# /7 1,148 f
JOB ADDRESS: .,...../.4, i d '
NEW OR REPLACEMENT INSTALLATION: Project Value$ 1, 990
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 ___L___
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory I 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:
o Sewer Replacement 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
o Lawn Sprinkler System-Number of Heads 0 Well **
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
O Other
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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 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 Phone Number
Plumbing Company le/742.,- /Kwt. h ,,....4.,,— ul Office Phone 9 '(77g-iT Fax
•
Co. Address: Vc71 34 3 itA-s -"Y City.5•440,....fic State F[- Zip 'zZ/v
License Holder(Print): 1 r% _ State Certification/Registration#, FC/y/2
legg
Notarized Signature of License Holde PIPa.
Aib'Befo - this day of =1t�_( j
_ 17 _
I-'f':"3.-*;,= MY COMMISSION$!'rr 92:951 Sign, of Notary P • is
j' 'r EXPIRES.00iCbv r.e0?9 e /
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\ iV Pubs:underwrters
'•;�pp�,,, Bonded Thru Notary