10 10th St 16-PLBG-448 plbg permit riS s� CITY OF ATLANTIC BEACH
0 800 SEMINOLE ROAD
J js' 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: 16 -PLBG -448
Job Type: PLUMBING ONLY
Description: 15 FIXTURES
Estimated Value:
Issue Date: 2/22/2016
Expiration Date: 8/20/2016
PROPERTY ADDRESS:
Address: 10 10TH ST
RE Number: 170237 -0012
PROPERTY OWNER:
Name: CLOISTER CONDOMINIUMS
Address: 10 TENTH ST
GENERAL CONTRACTOR INFORMATION:
Name: CROCKETT PLUMBING COMPANY
Address: 11331 PENDER RAULERSON RD QA WILLIAM JOHN
CROCKETT, JR
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State PLMG DCA Surcharge $2.00
State PLMG DBPR Surcharge $2.00
Plumbing Fixtures $105.00
Total Payments: $164.00
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 6 - f 6 C
800 Seminole Rd Atlantic Beach, FL 32233
qg
� Ph(904) 247 -5826 Fax (904) 247 -5845 n
JOB ADDRESS: I C 1 SS L . L C+ ( ...c. -- PERMIT # I CP - K/" /� 4-
7? ? 32 ?— l6/
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
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 3
Hose Bibs Urinal
Kitchen Sink / Vacuum Breakers
Laundry Tray Water Connected Appliances /
Lavatory j/ Water Heater _L y
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Lawn Sprinkler System - Number of Heads ❑ Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection. **
❑ 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 authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name lent -1 "4Y rii p h &- Phone Number
P/C Plumbing Company 01__60_, � (rM-a f a. Office Phon9 63i lQ Fax
Co. Address: 3L b p ' C CJ.'i // City -' Y la 0 C - State M Zip 3;4 / 3
License Holder (Print): ; l t t A. � .44-I_ : to Certification /Registration e F=D Siq `ti
Notarized Signature of License Holder , %4 -. • / o
r Notary Public State of Florida o rn and subscri • before • • :s Z day of � Ora 20
e
Shirley L Graham
a 4 trY
I My Commission FF 086990 S 0 afore of Nota • '
Fp f: o° Expires 02 /14/2018 , 1,
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