1021 Atlantic Blvd # 1023 Plumb 2014 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
Application Number . . . 14-00001203 Date 7/28/14
Property Address . . . . . . 1021 ATLANTIC BLVD
Tenant nbr, name . . . . . . UNIT 1023
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
back flow preventer
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Owner Contractor
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EQUITY ONE ATLANTIC VILLAGE, F.W. FAIR PLUMBING CO.
16 NE MIAMI GARDENS DR P.O. DRAWER 51558
ATTN: TREASURY DEPT JACKSONVILLE BEACH FL 32250
MIAMI BEACH FL 33179 (904) 241-7191
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee 62 . 00 Plan Check Fee . 00
Issue Date . . . Valuation 0
Expiration Date . . 1/24/15
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Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited ----Due---
----------------- ---------- ---------- ------
Permit Fee Total 62 . 00 62 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 66 . 00 66 . 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
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2-1 Ph(904) 247-5826 Fax (904) 247-/58,4�5� 16,z 3
JOB ADDRESS: 16 ,2JV / `�,V C� �- GV 1/ T PERMYr# d-1ZJ3
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
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOU :
❑ Sewer Replacement Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well
**SJR WD 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 authon/�to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name (�/L� tied Phone Numb e z /d l y
Plumbing Company ��`rU � Office Phone I-VA 7 1 9l Fa-2 Y' C/
Co. Address: a G I rl J-f City V� State Zip &,
License Holder (Print): A,�. State Certification/Registrati 4
Notarized Signatur f License Holder
of N Notary P�®[fldi�zb ribed bef e this � day o 20
Shirley L Graham
E °:o °' '1 �f N ary Pub]