1640 SEA OATS DR - PLUMBING r, n
. ' f CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
if
- f ATLANTIC BEACH, FL 32233
J
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-PLBG-3662
Job Type: PLUMBING ONLY
Description: PLUMBING - 4 FIXTURES
Estimated Value:
Issue Date: 4/3/2017
Expiration Date: 9/30/2.017
PROPERTY ADDRESS:
Address: 1640 SEA OATS DR
RE Number: 172020-0238
PROPERTY OWNER:
Name: PATTERSON, JARED M
Address: 1640 SEA OATS DR
GENERAL CONTRACTOR INFORMATION:
Name: COGBURN AND WAKEFIELD PLBG
John Cogburn, CFC1428140
Address: 5900 TOWNSEND BLVD APT 522 QA JOHN COGBURN
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $28.00
Trade Permit Base Fee $55.00
Total Payments: $87.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND 'I HE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 �
Ph (904) 247-5826 Fax (904) 247-5845 1 -7 -1--)Le,G -'3( 0Z.
JOB
JOB ADDRESS: v c 5.Q.,A. GA 12 Dz • PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
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 ___i`
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray . -- Water Connected Appliances
Lavatory a 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
11 Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
Sewer Replacement Back Flow Preventer [ i Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
C Lawn Sprinkler System-Number of Heads ❑ Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
ii 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 governing this work will be complied with whether specified
or not. The permit does not give aut ority to violate the provisions of any otherhestate or local law regulation construction or the performance of construction.
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Property Owners Name A SopJ / g .)5w [.).k,I 61 t1 Phone Number `]o'i- Z`i/•0320
p
PlumbingCompany l_o bu2� a,.dl W/a-)AOt•P'4 ') thfice Phone CYc I 3?y•35S3Fax
Co. Address: (p o S City SA-k State -Fl Zip 322/O
License Holder (Print): .-'t o LA CO 6,. _1„.,. . t. .' Certification/Registration# CPC IL(2.Ss)'2'D
AW
Notarized Signature of License Holder
Denise A.Ennis Sworn and s (cribed befo • ••e this 3 day of Actor t\ 201'.
•
�' NOTARY PUBUC
`V STATE OF FLORIDA Signature of Notary Public �
--lig"'-" - Corral FF966426
Expires 3/1/2020