Permit Docs on Expiration 2010 J ° fk
- , ` s,, CITY OF ATLANTIC BEACH
J , 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
Z Jt.6 c
Application Number 10- 00001388
Property Address Date 11/18/10
72 17TH ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
irrigation
Owner
Contractor
DAI XIAO -QIONG AA MCCOY IRRIGATION
P 0 BOX 2899 5013 CERISE ST
DURHAM NC 27715 JACKSONVILLE
FL 32258
(904) 268 -7433
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee
Issue Date 00
Expiration Date . . 5/17/11 Valuation 0
Other Fees STATE PLBG DCA SURCHARGE
STATE PLBG DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 62.00 62.00 .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.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 -5845
JOB ADDRESS: Ulf-11
PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE
Bathtub QTY
Clothes Washer Septic Tank & Pit
Dishwasher Shower
Drinking Fountain Shower Pan
Slop Sink
Floor Drain
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Laundry Tray Vacuum Breakers
Lavatory Water Connected Appliances
Other Fixtures Water Heater
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 p
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑Back Flow Preventer ❑Grease Interceptor (Trap) gallons
-- (Requires 3 sets of plans)
t Sprinkler System - Number of Heads IS (> ❑ Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection. **
❑ 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 authority 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 , (4. A 01 (Co , ,2 K ,1G #4 .2 i ;,.) Office Phone %c r 2 C - 7y 3 ?Fax S'c C, 02 4f 43
Co. Address: S c eti+5e / s-° City State Zip
License Holder (Print): 1 ,A 11 4.7 _State Certification/Registration # .1 E<I
Notarized Signature of License Holder
Sworn and subscribed bef. 1 a "'" r :I 21 I/ ,, af,,lti; 0
Signature of Notary Public = _ / �i „ -� ` . . I
r �� ' 4 \ CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
J3ilS3I
Application Number 10- 00001389 Date 11/18/10
Property Address 76 17TH ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
irrigation
Owner Contractor
DAI XIAO -QIONG AA MCCOY IRRIGATION
P 0 BOX 2899 5013 CERISE ST
DURHAM NC 27715 JACKSONVILLE FL 32258
(904) 268 -7433
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee . .00
Issue Date Valuation 0
Expiration Date . . 5/17/11
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
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.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 -5845
JOB ADDRESS: t 0 1-'4 7 --
PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE
Bathtub QTY
Clothes Washer Septic Tank & Pit
Dishwasher Shower
Drinking Fountain Shower Pan
Floor Drain ---- Slop Sink
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Laundry Tray Vacuum Breakers
Lavatory Water Connected Appliances
Other Fixtures Water Heater
Water Treating System
RE -PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE
Bathtub QTY
Clothes Washer Septic Tank & Pit
Dishwasher Shower
Drinking Fountain Shower Pan
Floor Drain Slop Sink
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Laundry Tray Vacuum Breakers
Lavatory Water Connected Appliances
Other Fixtures Water Heater
Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) g allons
sawn Sprinkler System - Number of Heads _2/2_ ❑ Well **
(Requires 3 sets of plans)
** SIRWD Well Completion Form. Completed form to be submitted to the Building Department for fmal inspection.**
❑ 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
ar 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
Phone Number
Plumbing Company f . p'✓t cZ Z
, .� b.���e�,.
y CA, C Office Phone Al - • 74 33 Fax 2 2 y3t
: Address: _c 4� ZtS�y 5 i —
City :Plc es kit State ,`" Zip .3.2____ ,2
License Holder (Print): A . A 14/7
.y � ^ State Certification/Registration # �- l
Votarized Signature of License Holder .
Sworn and subscribe o * � .: ,:
� . 'Y : t i
Signature of N Pub , ,� ( � , 2014 , , j
Sign Notary P _.. *KT • a .A