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Permit Plbg 1854 Seminole Rd 2010 , f - CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD = ` =" ATLANTIC BEACH, FL 32233 r... p w, . p INSPECTION PHONE LINE 247 -5826 �4J33a` Application Number . . . . . 10- 00001319 Date 10/29/10 Property Address 1854 SEMINOLE RD Application type description PLUMBING ONLY Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc bath remodel Owner Contractor MCKENNA WILLIAM STEEG PLUMBING 1854 SEMINOLE RD 1601 MAIN STREET JACKSONVILLE FL 32209 ATLANTIC BEACH FL 32233 (904) 249 -5191 Permit PLUMBING PERMIT Additional desc . 3 FIXTURES Permit Fee . . . 76.00 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date . . 4/27/11 Other Fees STATE PLBG DCA SURCHARGE 2.00 STATE PLBG DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 76.00 76.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 80.00 80.00 .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 r Ph (904) 247 -5826 Fax (904) 247 -5845 JOB ADDRESS: /f 5V / '5 /h <. PERMIT # NEW OR REPLACEMENT INSTALLATION: Project Value $ TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank & Pit Clothes Washer Shower / Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Dram 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 FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank & Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compaituient Sink Floor Sink Toilet 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 ❑ Lawn Sprinkler System - Number of Heads ❑ 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 re 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 specifies or not. The permit does not give authority to violate the provisions of any other state or Iocal law regulation construction or the performance of construction. Property Owners Name A /1 7 1 L- ,kl A h fr Phone Number Plumbing Company eG ,t)305 e 2+^ - Office Phone i9 f/ Fax 2.YJ c3 9 r b Co. Address: /6 1 / A i -. 5 City bit * ). State 0 Zip ?✓' Z233 License Holder (Print): -1 Wl. - State Certification/Registration. # £ /? o32/5'L Notarized Signature of License Holder fJ 41- Sworn and s scribed be me this day of 20__ Signature of Notary Public