Permit 390 12th Street CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
-Dill,
Application Number . . . . . 10-00000667 Date 5/26/10
Property Address . . . . . . 390 12TH ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
Sprinker System to existing well
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Owner Contractor
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BIRCHFIELD, HAROLD L. HULIHAN TERRITORY
390 12TH STREET P.O. BOX 331268
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 270-8377
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Permit . . . . . . PLUMBING PERMIT
Additional desc . . SPRINKLER ON EXISTING WELL
Permit Fee . . . . 62 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 11/22/10
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Fee summary Charged Paid Credited Due
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Permit Fee Total 62 . 00 62 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 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(904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: "z PERMIT
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
MISCELLANEOUS:
0 Sewer Replacement 1:1 Back Flow Prevenjp?---7D,Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
V/L'awn Sprinkler System-Number of He s El Well
(I*oo be submitted to the Building Department for final inspection."
SJRWD Well Completion Form. Comp?e ed f
F� Other
Permit becomes void if work does not commence within a six month perioA-of'work is suspended t—orabandoned for si months.I hereb I y certify that I have read
r
Lhis application and know the same to be true and correct. All provi��s of laws and ordinances goveming this]�qrk ill be complied with whether specified
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Drnot. The permit does not give auth *tytoviollatethepro KC f th t te r lollo la i cons c ion or the performance of construction.
O�er sl
el
Property Owners Name /"-4 1�,r P e
717 0 any Phone Number J�c)�
Plumbing Company Phone FJ-'P-J-W_r Fax -2 ';;o 2 2.7 o
t_"CZ
,,o. Address: ZI'Z;7 -17%Vhz city State Zip
License Holder (Print): 176 State Certificatior-VRegistration# _L
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Votarized er
MY COMMISSION#DD 634
EXPIRES:May2l,
ad Thru NomryhW Mom ind subscribed before ie s f 20
Signature of Notary Public4n��_ .���.'