Permti 185 Poinsettia Street CITY OF ATLANTIC BEACH
SS
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
0 jilt
Application Number . . . . . 10-00000547 Date 5/03/10
Property Address . . . . . . 185 POINSETTIA ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
----------------------------------------------------------------------------
Application desc
REPIPE
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
ANDERSON DEAN SCOTT STEEG PLUMBING
18S POINSETTIA STREET 1601 MAIN STREET
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 249-5191
----------------------------------------------------------------------------
Permit . . . . . . PLUMBING PERMIT
Additional desc . . REPIPE
Permit Fee . . . . 139 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 10/30/10
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 139 . 00 139 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 139 . 00 139 . 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
1_ PERWY Zo
JOB ADDRESS: A-5- '111�euc-lo -
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE oF FIXTURE QTY TYPE oF FixTup.E QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Dram Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry"fray 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:
El Sewer Replacement o Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
1:1 Lawn Sprinkler System-Number of Heads Ei Well
** SJR WD Well Completion Form. Completed form to be submitted to the Building Department for fmal inspection.
Ei 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 authori to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name Phone Number
Plumbing Company C_ek, —Office Phone Fax
State &zip 3A .7-7,
Co. Address:
_v A9 city
Li Or rq _�Ac 1-4 State Certification/Registration# _Z
D634126 Ider
No 4091RUNgose 4.6.,r 1461. e,4
Bwded Thru Notary Pubft UndarAnftts dayof 2(Y"D
Sworn nd) bscribed belore yte 41i P 2— 1 —
Signature of Notary Public MA���W_