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
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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
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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