875 BEACH AVE - PLUMBING 'kJCITY OF ATLANTIC BEACH
` 1.26
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-3868
Job Type: PLUMBING ONLY
Description: PLUMBING - SEWER REPLACEMENT
Estimated Value:
Issue Date: 5/1/2017
Expiration Date: 10/28/2017
PROPERTY ADDRESS:
Address: 875 BEACH AVE
RE Number: 170332-0000
PROPERTY OWNER:
Name: GRAND, WALTER & LAURA, *
Address: 114 CHAPIN PKWY
GENERAL CONTRACTOR INFORMATION:
Name: PIPE-RIGHT PLUMBING SVC INC
Carl David Hamm, RF11067554
Address: 1311 TROTTERS WALK WAY
Phone: - -
FEES:
Plumbing Fixtures $7.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 ' Q _3
Pb(904)247-5826 Fax(904)247-5845 , 7 - P W CSO
Q r6Ie PERMIT#
JOB ADD ss: /� 75—
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF F.TXTURE QTY TYPE OF FIXTURE QTY
Bathtub • Septic Tank&Pit
Clothes Washer Shower
DishwasherShower Pan
Drinking Fountain Slop Sink
Floor DrainThree Compartment Sink
Floor Sink Toilet
Hose BibsUrinal
Kitchen Sink Vacuum Breakers
Laundry TrayWater Connected Appliances
Lavatory Water Heater
Other FixturesWater Treating System
RE-PIPE: •
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
BathtubSeptic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking FountainSlop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal Vacuum Breakers •
Laundry Sink Water Connected Appliances
Tray Lavatory Water Heater
Fixtures —77-
Water Treating System -_
Other
M CELLANEOUS:irie (Requires 3 sets of plans)
Sewer Replacement 0 Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(R q
❑ Lawn Sprinkler System-Number of Heads ❑ Well
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
o Other
doned
s.I hereby certify
at I have
thisPermit becomes void if work does not commence cwithin a six orrect. Allrprovisionsmonth
of lawsork is and ordinancesdor governning this for
will be complied with whelther specified
this applicationt. Theand know the same to rie true and
or not. The permit does not give authority to violate the rovisions of any other state or local law regulation construction or the performance of construction.
1.L Phone Number
Property Owners Name � �p 6,z -40S2- Fax
��e ��• /7 ee .4, Z Office Phone
Plumbing Company � ,� � State /. Zip3722�.S
Co. Address: / ro i � City : 4�
License Holder(Print): _ . D .. /(1,...: � State ate Certification/Registration#�r`/Ot 733
Notarized Si:nature of License Holder AlliWATAINIIIhrillia
:v .efore me this day of ,�Millail 20 V
o,. ..yQ*i TONIGINtxESPERGER
MY COMMISSION#FF 924951
>`•• EXPIRES:October 6,2019 # • 1
'_;o�ttd''; Bonded Thru Notary Public Underwriters signature of Notary Public M v.