262 2nd St Plumb 2015 s, CITY OF ATLANTIC BEACH
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: 15-PLBG-926
Job Type: PLUMBING ONLY
Description: 21 fixtures
Estimated Value:
Issue Date: 4/22/2015
Expiration Date: 10/19/2015
PROPERTY ADDRESS:
Address: 262 2ND ST
RE Number: 172542-0000
PROPERTY OWNER:
Name: SMITH III,CARL HOLT & JULIA L,
Address: 4670 BADEN LN
GENERAL CONTRACTOR INFORMATION:
Name: WAYNE CONN PLUMBING INC.
Address: 5627 -#7 V VERNA BLVD QA VERNON SPARKS
Phone: - -
FEES:
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Plumbing Fixtures $147.00
State PLMG DBPR Surcharge $2.00
Total Payments: $206.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: �(— � 7� PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE oFFIXTum QTY TYPE oFFIXTURE 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 oFFIXTURE QTY \ TYPE oFFIXTURE QTY
Bathtub nl 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 ❑ 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 <AA4� % / � Phone Number
�� 6al � cPlumbing Company � f � 3b�/ ?F �1 tt--
�/GcO `�
Co. Address:,:W 7 �/ �.� City ,7 f� State�� Zip
License Holder (Print): S State Certification/Registration#
Notarized Signature of License Holder
Before me this day of 20
Signature of Notary Public