Permit Plbg 2010 NTIC BEACH
CITY OF ATLA
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00001088 Date 8/31/10
Property Address . . . . . . 475 SELVA LAKES CIR
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
12 fixtures
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Owner Contractor
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CASEY, BRIAN T. STEEG PLUMBING
475 SELVA LAKES CIRCLE 1601 MAIN STREET
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 249-5191
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 139 . 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 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
JOB ADDRESS: /I PFRwr
t
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE oF FbcTuRE QTY TiPE 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 FfxTuRE QTY TYPE oF FjxruRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet —3
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
1i Sewer Replacement Ei Back Flow Preventer F7 Grease Interceptor(Trap) gallons(Requires 3 sets of plam
D Lawn Sprinkler System-Number of Heads r7 Well
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.*
0 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
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 speciflec
or not. The permit does not give authority to violate the provis.ons;of any other state or local law regulation construction or the performance of construction.
Property Owners Name 1A 17 ?,j49J-e-4f Phone Number
Ly
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._._ OfficePhone /91 Faxt�VI�W.9r
Plumbing Compar __ _.-A
Co. Address: 161) Z city A#' AV State_)9
License Holder(Print): _T1 State Certification/Registration# Mro_-3 7�%-
Notarized Signature ofLicense Ho r
20
Swom and s4cribed before me this day of
Signature of Notary Public