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Permit 396 4th St 2010 replace sewer line CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 10-00001506 Date 12/30/10 Property Address . . . . . . 396 4TH ST Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc REPLACE SEWER LINE ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ TIERNAN, RALPH AMELIA PLUMBING 396 4TH STREET 2232 FLORIDA BLVD ATLANTIC BEACH FL 32233 NEPTUNE BEACH FL 32266 (904) 821-8355 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . REPLACE SEWER LINE Permit Fee . . . . 62 . 00 Plan Check Fee . 00 Issue Date . . . . valuation . . . . 0 Expiration Date . . 6/28/11 ---------------------------------------------------------------------------- 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. 12/30/2010 09:28 9042235365 PAGE 01/01 PLUMBING PIERMIT APPLICATION CITY OF ATLANTIC 13EACH 800 Seminole Rd Atlantic Beach,FL '72233 Ph(904) 247-5926 Fax(904)247-5945 013 ADDUSS: Is PERMIT IEW OR REPLACEMENT INSTALLATION: Project Value s TYPE OF FfXTURE QTY Tymp o.F Frxmn OTY Bathtub Septic Tank&Pit Clothes Washer Shower Dishwasher Shower Pan Drinl(ing Fountain Slop sinic Floor Drain Three Compartment Sink Floor Sink Toilet ,Rose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray W&ter Connected Appliances Lavatory Water Heater Other Fixtures Water Trcatin-System 7'ypz OF FrxruRE QTY TYPE OF Fixrum QTY Bethtub Septic Tank&Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Hose 13ibs. Urinal Kitchen Siok VacuLun Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater Other Fixtures Water Treatiag System 41SCELLANEOUS: /Tsewer Replacement o Back Flow Preventer o Grease Interceptor(Trap) gallons(Requires 3 sets of plans) Lawn Sprinkler Systerri-Number of Heads C:l Well SJRWD Well Completion Form. Completed foa be submittedto die—Building Department for final inspection.** 3 Other ermit becomes void if work does not commence within a six roonth period or work is suspended or abandoned for six months.I hereby certify that I have read as 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 r not The permit does not give authority to-a0late the'Provisions of at5,other state or local law rqulation construction or the performance of construction. Iroperty Owners Narne ?ro ocr+v PhoneNumber —A4�— fla6� "�O Fax . 5, IlumbirIg Company -Office Phone 'o J Address; city State zip�V-9� Li I _icease Holder Stal;e Cellificat' CQ�L%tration Pif U�J'l 6—q I \1cf.errizedT LS_'ignature of Zicens-e Holder miCHEL,1'_'L,WALDA� rn and subscribed before me this day of O'LA—V-)C 201 C) commisslon 00 688740 i ture of Notary Publik. �iune25,2011 Exp1res _Alk(J'1j_LP_C' . L J,AJQ__).