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
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Application desc
sewer replacement
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Owner
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Contractor
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JOHN MOON PLUMBING
1103 PALM CIRCLE
JAX BEACH FL 32250
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Permit PLUMBING PERMIT
Additional desc .
Permit Fee 62.00 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date 12/06/10
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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