Permit Plbg 5103 Polaris CT 2010 IS CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00001205 Date 10/06/10
Property Address . . . . . . 5103 POLARIS CT
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 7000
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Application desc
renovate bath/shower
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Owner Contractor
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PRESTIGE BUILDERS & REMODELERS
848 AILY CHURCH LANE
SEVIERVILLE TN 37876
(904) 662-1528
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Sub Contractor . . DAVID GRAY PLUMBING INC.
Permit Fee . . . . 69 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/04/11
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Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONALELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 34
STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 34
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 69 . 00 69 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 8 . 68 8 . 68 . 00 . 00
Grand Total 77 . 68 77 . 68 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Mar 08 10 12:54p Information SystemsCFFY 0 904-247-5845 P.1
PLUMMING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845
JOB AiDDREss: St6-; (P61-09(!r PERMrF 9
NEW OR REPLACEMMNT INSTALLATION: Project Value s
TYPE oF FzrruRE QTY TYPE oF F)xruRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
-Disirwasher -ShowerPan
Drinkiing Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs "Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected AppIiances
Layatl�ry Water Heattr
-0ther'Fixtures Water Treafing System
RE-PIPE;
TYPE oF FEcvpE QTY TYPE oF FL%7vRE Qlry
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor E�iain ......... Three Compartmemt Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Bmak-=
LAundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
AUSCELLANEOUS:
F-i Sewer Replacement 11 Back Flow Preventcr 0 Grease Interceptor CFrap)_gaIlons(Requires 3 sets of plans)
0 hawn�pfinlder System-.Number of Heads 0 Well
** &TAWDWell Ggmpl5pp- n Form. Completed form to be submitted to the Building Department for rMal.inspection.**
o Other. I?
Permit becomes void if work does not commence i hin a six month period or work is suspended or abandoned for six months.I hereby certii�v that I have read
this an lication.and know the mme to be true and cot. ct. All provisions of lzws and ortlinances governing thiswork will be complied with whether specificd
.P
or not. Tbc parmit does-not give authority to violate the pro-visions of any other state or local law regulation construction or the performance of construction.
Property Owners Name fir�ff,- 1,44f V/w Phone Number 0'0
Plumbing Company —Waiv-,,id Gray Plumbing, Inc. Office Phone 71r4-1k-4� -F ax
88M t0rpCrate Squd#r, U-UUIL'
Co. Address: Jack-sowhilo. Eincida 32216 city State—Zip
License Holder(Print): P"10 i� State Certification/Registration#
Notarized Signature of License Holder
Sworn and subscribed beorF,mF- day of 20
Signature of Notary Public
(P No ry Public State of Flodnda
ta major
R major 0
k Neal
my commission DD602560
"i r 01 010
OF Ex ires 12/2012010