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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