381 5th ST - PLUMBING r-S y\J�:1
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CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J� ATLANTIC BEACH, FL 32233
___________3-,;-.....,..-*- -- ,_. 9
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-PLBG-3759
Job Type: PLUMBING ONLY
Description: PLUMBING - 23 FIXTURES
Estimated Value:
Issue Date: 4/13/2017
Expiration Date: 10/10/2017
PROPERTY ADDRESS:
Address: 381 5TH ST
RE Number: 169878-0000
PROPERTY OWNER:
Name: MORRISSEY, MELISSA
Address: 381 5TH ST
GENERAL CONTRACTOR INFORMATION:
Name: Jacksonville Plumbing Co
, CFC41786
Address: 5836 Old Timuquana Road Jacksonville, FL 32210-7877
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $154.00
Trade Permit Base Fee $55.00
Total Payments: $213.00
1'F.RoIIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
RI'II.DING 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- P L S G - -3-75c)
JOB ADDRESS: T \ 5TH 5 T • PERMIT# B\(c -" Off.
NEW OR REPLACEMENT INSTALLATION: Project Value$ V'a-1 cc
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower 3
Dishwasher _ i Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 14
Hose Bibs Q Urinal ,
Kitchen Sink ___I____ Vacuum Breakers
LaundryTray1 - , ater Connected Appliances
Lavatory 5 ater Heater , �
Other Fixtures ater Treating System 1 SacL
bre,
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RE-PIPE:
TYPE OF FIXTURE Q.Y 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 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads 0 Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ 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 111‘. .L.,17-55A nibr_ S5E-y Phone Number
Sc kStv��v�La.-C ��. e. Office Phone`I M 511 Fax"C1q—SZFR
Plumbing Company,
Co. Address: 5551[4, Oc-c =rr e'• City Stated.. Zip 3 ?- 11
License Holder(Print): Lie Y C'-S.---1 . State Certification/Registration#CF C&4 t' V
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Notarized Signature of License Holder / a;
_;_ ------- ERGER Before me this _ day o �� c ,___�20
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j,':ovg,,; TON131NOLESP P
7.. MY COMMISSION FF 924951
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Signature of Notary Publ
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