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Permit Plbg Water Heater 97B Dudley 2010 .` 11-A- . 1 Y CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 Application Number 10- 00001335 Date 11/03/10 Property Address 97 DUDLEY ST B Application type description PLUMBING ONLY Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc WATER HEATER Owner Contractor JACKSONVILLE HOUSING AUTHORITY FLI9TLIONSIRUCTION SVCS(PLBG) ATLANTIC BEACH FL 32233 ATLANTIC4BE6CH FL 32233 Permit PLUMBING PERMIT Additional desc . WATER HEATER .00 Permit Fee . . . 62.00 Plan Check Fee . Issue Date Valuation . . • • 0 Expiration Date . . 5/02/11 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: q 7 o)ic(f S/ , g PER1vHT # / 3 3 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 Drai1 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 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 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 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 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 - Ft CAS v U 4 4 ;7 1,1/41_,/, Phone Number 6 ©- 3./ Plumbing Company Hi4T 6,0 5 7 t.v c7 &k° ,/ Office Phone 7'94 0 026 Fax 7 0 2 ^ Co. Address: iLW 44 / 5 r r h Di'( v City 4//e,,/ c. 4,4 State f Zip 1 ? -� - License Holder (Print): /( State Certifica ' n/Re istratio (FC Notarized Signature o /�i!t r a ,__ — - —" °E n day of 20 MISSION DD w►, and subscribed before me this ' > i %:: «? MV yp REs M P Y uo aerw�te� �-- , u � F. Noun � nThn • ature of Notary Public XetAat—e--