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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 � ---------------------------------------------------------------------------- Application desc REPIPE 12 FIXTURES ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ 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 -----------------------------------------------7---------------------------- 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 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 09 STATE PLBG DBPR SURCHARGE 2 . 09 ---------------------------------------------------------------------------- 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