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Permit 393 4th StreetCITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 Application Number 10-00000744 Date 6/09/10 Property Address 393 4TH ST Application type description PLUMBING ONLY Property Zoning TO BE UPDATED Application valuation 0 ---------------------------------------------------------------------------- Application desc sewer replacement ---------------------------------------------------------------------------- Owner ------------------------ Contractor ------------------------ JOHN MOON PLUMBING 1103 PALM CIRCLE JAX BEACH FL 32250 ---------------------------------------------------------------------------- Permit PLUMBING PERMIT Additional desc . Permit Fee 62.00 Plan Check Fee .00 Issue Date Valuation 0 Expiration Date 12/06/10 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total Plan Check Total Grand Total 62.00 62.00 .00 .00 .00 .00 .00 .00 62.00 62.00 .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 (9~ 47-5826 Fax, 0904) 247-5845 Jos ADDRESS: ~~~ -~..~.~'~ ~~i~k'~..~ PERMIT # NEW OR REPLACEMENT INSTALLATION: TYPE OF FIXTURE Bathtub Clothes Washer Dishwasher Drinking Fountain Floor Dram Floor Sink Hose Bibs Kitchen Sink Laundry Tray Lavatory Other Fixtures RE-PIPE: TYPE OF FIXTURE Bathtub Clothes Washer Dishwasher Drinking Fountain Floor Drain Floor Sink Hose Bibs Kitchen Sink Laundry Tray Lavatory Other Fixtures Septic Tank & Pit Shower Shower Pan Slop Sink Three Compartment Sink Toilet Urinal Vacuum Breakers Water Connected Appliances Water Heater Water Treating System MI ELLANEOUS: ewer Replacement ^ Back Flow Preventer ^ Grease Interceptor (Trap) gallons (Requires 3 sets of plans) ^ Lawn Sprinkler System-Number of Heads ^ Well * ** SIRWD 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 pr i ions of any other state or local law regulation construction or the performance of construction. Property Owners Name ~i--' ~ Phone Number Plumbing Company ~ N Office Phone ~ ---~7 Fax ~--~ Co. Address: ~ ~ ~ City State ~~ Zip License Holder (Print): ~-- State ertification/Re •stration ~~/ Natcarizecl ,5i~aaattcr°e o~'~leerase I~olclea' TAY , .i Swoi-~z subscribed b O ~~ •*: AYC Miss i3~r $ ~ 20 rd`; rY "'~ •• on of P 6c ers Signature of Notary Publ Project Value ~ QTY TYPE OF FIXTURE QTY Septic Tank & Pit Shower Shower Pan Slop Sink Three Compartment Sink Toilet Urinal Vacuum Breakers Water Connected Appliances Water Heater Water Treating System QTY TYPE OF FIXTURE QTY