Permit Plbg 61 Ardella 2011 , ra .
C _ , ` ' CITY OF ATLANTIC BEACH
r'' �� S
r-' iii a 800 SEMINOLE ROAD
`) ` X ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
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Application Number 11- 00002270
Property Address Date 7/14/11
RD
Application type description RESIDENTIAL ALTERATION
Property Zoning TO BE UPDATED
Application valuation . . . 5000
Application desc
interior repair
Owner Contractor
BOEREM SONSHINE CONSTRUCTION, INC.
61 ARDELLA ROAD 910A 3RD STREET
ATLANTIC BEACH FL 32233 NEPTUNE BEACH FL 32266
(904) 838 -7563
Permit PLUMBING PERMIT
Additional desc .
Sub Contractor . TDG PLUMBING
Permit Fee . . . 69.00 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date . . 1/10/12
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 69.00 69.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 73.00 73.00 .00 .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: (p l A rc a LLA PERMIT # //' 2Z 70
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer
4----- Shower __t___
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 4:2,
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
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 0 Au : 8 Q oe Item M Phone Number al 7 - & 7 L 2 '
Plumbing Company, D .L e (.0.4•4 r.". I ' ,el.c Office Phone I r- "1Z 4 / Fax $"( --/SITS'
Co. Address: IN24 1...o•3 ba. City p'C State /CC. Zip r IVO
License Holder (Print)75„py ✓: 9 0 GA:✓►o I State Certification/Registration # . FG.1 4 - ?e - ? 4
Notarized Signature of License — __ _
"` CHIRI FYI la pANei,1
f*: Ah :: MY COMMISSION kDD 957760
w "`v: • z -,- �
� t►,l for; me )this • ay of 20
Signature o 1 o ary • u • P - ..._
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