Permit Plbg 830 Cavalla Rd 2010 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00001270 Date 10/20/10
Property Address . . . . . . 830 CAVALLA RD
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
1 FIXTURE
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Owner Contractor
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-WHITE THOMAS M ROLLAND REASH PLUMBING .
784 CRESTWOD DRIVE 11501 W COLUMBIA PARK DR #208
ST AUGUSTINE FL 32086 JACKSONVILLE FL 32258
(904) 260-7059
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 62 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/18/11
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Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 62 . 00 62 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 66 . 00 66 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
10/17/2010 11:08 9042600916 ROLLANDREASHPLUMBING PAGE 01/01
PLUMBING' PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Scminole Rd Atlantic Beach, FL 32233
Ph (904)247-5826 Fax (904) 247-5845
JOB ADDRFUSS: e3o
_fAV.,4g.6 oep, , 0 PE RMIT#
,qr,A
60_ FZ
N ilk
NEW OR REPLACEMENT INSTALLATJON: Project Value s_,5'
60,w ., �� W ,
TYPF or Fixrun QTF TYPE OF FtxruRE QTY A-
bnthttlb Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pon
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
r
�1001_Sink Toilet
14oqe Bibs Urinal
1(itclicnSink Vacuum Breakers
Laundry Trny Water Connected Appliances
Lavatoi-y Water,14cater
Other Fixturc.q Water Treating System
RE-PIPE:
TYPE OF r,IXTURE QTY TYPE OF r-wuRr; QTY
Bathhib Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor 13r-,)in Three Compartment Sink
Floor Sink Toilet
Hose Bihs Urinal
Kitchen Sink Vacuum Breakers
Tlundry Tray Water Connected Appliances
Lavatory Water 14catcr
Other FiXtIlTeS Water Treating System
MISCELLANEOUS:
i..iScwcrRcplaccmcnt � i Back Flow Pteventer M Grease Interceptor(Trap)_gallons(Requircs 3 sets of plans)
F1 Lawn Sprinkler Systern-Number of 1-leads I---; Well
" S.IRWI) Well Completion rorm. Completed form t be submitted to t5he-lTu—ilding Department for finall inspection."
i-i Other
PCITnit Occom,void i I'work does not commence withino six rmonth period or work is suiponded or nband"n dkr six niontl%.�.I hereby ccrfl fy that I liavc rcad
this"Irplicatinn"Ind know thexamc to bc true and correct. All provisions orliwsmid ordiriances governing this work will be comr1ted with wticther specified
or not. The permit doe-,noi.givcnuthotlty to violitc the provisjoris 01'any other St"itc Or IM8.1 1AW regulation conqtruction orthe rertbonancc ofconRtruction,
Property Owners Narne Phone Number
Pliimbing Conipatly P-,�—OU-P
rND - 11 P-Ljm i6Lc- Office Phone Q!Ab-r?09'9 FaxXo -NIU
Co-Address: 11,S81 0-OLUMAIR AKK De-, UK Sg;MT-,qp2 city State EL— ZiP 3-2.1-5 A
UZAVIr
License.Holder (Print): Ro LIAM Q JQ F-AS H — StateC ��io.n�/Rcgistrati.o.n #CEC,- Oqfz)?L
irnpiure qfLicenve Holder
it,RAOSY
Sworn and subscribed before me this -dayof- nctA- 4-1, 201t
"my polle-State of Florldf,
WCOMMISINEXPIM J8023,2011 ignaturc of Notary Public
Comefteloto 0 Do 626700