Permit Irrigation 160 11th St 2010 ,
S f� CITY OF ATLANTIC BEACH
i i ;� 800 SEMINOLE ROAD
,.,..:' ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
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Application Number . . . . . 10- 00001435 Date 12/06/10
Property Address 160 11TH ST
Application type description IRRIGATION /SPRINKLER
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
low spray irrigation
Owner Contractor
HAMIL HICKORY CREEK IRRIGATION
160 11TH STREET 12615 IVYLENA RD
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32225
(904) 221 -0605
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 6/04/11
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: ` / 7O 1/4(1 PERMIT #
3 2—.31
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 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
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 Eack Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
"Lawn Sprinkler System - Number of Heads l 8 ❑ Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection. **
❑ Other /x'11 S p/24
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 1,�0 Phone Number (0 3 1 6 2-66
Plumbing Company 4iIa' . Office Phone zz o 6° s Fax 2-2J OO Z
Co. Address: 1 t S - ,/s-t tc ( City 5'I Stater ( — Zip 3u2
License Holder (Print): Crv`t St ` 2- 36 State Certification/Registration # 2
Notarized Signature o License Holder . •, el SHIRLEY L G -erg) g � * r wMMISSID DD •.7760
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Sworn and subscribed beLfpt t
1-,2014 : 20
Signature of Notary Public _L. as!/:_
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