380 19th Street 12-00001790 Plumbing Permit 5-10-2024 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
A TLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
it
Application Number . . . . . 12-00001790 Date 12/06/12
Property Address . . . . . . 380 19TH ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0 �
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Application desc
REPIPE 12 FIXTURES
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Owner Contractor
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PETLEY, PHILIP L F.W. FAIR PLUMBING CO.
380 19TH STREET P.O. DRAWER 51558
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 24 1-7191
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Permit . . . . . . PLUMBING PERMIT
Additional desc . . REPIPE 12 FIXTURES
Permit Fee . . . . 139 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 6/04/13
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Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 09
STATE PLBG DBPR SURCHARGE 2 . 09
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 139 . 00 139 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 18 4 . 18 . 00 . 00
Grand Total 143 . 18 143 . 18 . 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: PERmrr '7q6?
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FLYTuRE 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 4 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 2.,7 Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
1:1 Sewer Replacement o Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
El Lawn Sprinkler System-Number of Heads El Well
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for fmal inspection."
El Other
Permit becomes V�oid 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 authoXnto violate the provisions of any other state or local aw regulation construction or the performance of construction.
Property Owners Name Phone Number
2
I'm e)�Ji 1-7 Fax7
Plumbing Company I U Office Phone?
Co. Address: City 1-'& StateF(, zip rl
License Holder (Print): t-- I .
t e Ger-t1fication/Registration
Notarized Signature of License Holder FL -PL qI q- 0
4 Notory Public Stift of FlorMa wom and subscribed b\ef e me this (9_(t� day of -Mem-56Z 20 1)—
Dayna H WiNlams
MY commission EE1 19675
E.Pi..0"7=15 ignature of Notary Public