Permit Plbg Repipe 2010 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
-5826
INSPECTION PHONE LINE 247
Application Number . . . . . 10-00001086 Date 8/31/10
Property Address . . . . . . 2039 SELVA MADERA CT
Application type description PLUMBING ONLY
Property zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
14 fixtures
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Owner Contractor
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LEBLANC MATTHEW & CATERINE NELSON PLUMBING CO. INC.
2039 SELVA MADERA CT. 11590 DAVIS CREEK ROAD E
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32256
(904) 262-4884
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 153 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 2/27/11
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 153 . 00 153 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 153 . 00 153 . 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
/7A
JOB ADDRESS: ecmc/ —(Se&a PERmurr
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE oF FmTuRE QTY TYPE oF FLxTuRE 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:
YPE oF FLYTup.E QTY TYPE oF Fbcmm QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shbwer 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 0 Back Flow Preventer 1:1 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 forflinal inspection."
ii Other
Permit becomes void if work does not cornmence 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 provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name T65k__1411 M Phone Number �3 4-1
Plumbing Company.NeASC)O ?1 ULm Ic;t LILR ColflC_ Office Phone 06D-14 7'9(4 Fax SZ3-313�
Co. Address: 1 1) '-POA)k ZS ClacL i State F I zip 3 Z 25(,::)
i
License Holder(Print): —D rT- tS)OES ta Certification/Registration 9
Notarized Signature of License Holde
LISA P.BASS V V Vt 3 1 d rday 20 /0
4O?AR11Pu8L'c STATE OF FLORIDA Sworn and sub bed before in this of
COMMis&614#DD726213
EXPIRES 11/16/2011 P;r
BONDED THRIJ 1-886-NOTARYI Signature of Notary Public