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Permit 338 4th Street PLUMB 2011 A CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 11-00001667 Date 2/10/11 Property Address . . . . . . 338 4TH ST Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 10 fixtures ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ STEELE, ALI DELANEY STEEG PLUMBING 230 LORA STREET 1601 MAIN STREET ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 249-5191 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 125 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 8/09/11 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00 STATE PLBG DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 125 . 00 125 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 129 . 00 129 . 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: PERmrr NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE oF FixTuRE OTY 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 FrxTuRE QTY TYPE oF FixruRE 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 2— Water Heater Other Fixtures Water Treating System MISCELLANEOUS: !�] Sewer Replacement [3 Back Flow Preventer Ei Grease Interceptor(Trap) gallons(Requires 3 sets of plans 11 Lawn Sprinkler System-Number of Heads o Well **SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.* o 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 specifiec 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 Phone Number *e_ 'L"�2A t4l e-t�� Jax z5�5�7' Plumbing Company Office Phone Co. Address: //"�91 City i'�IA State A(' Zip License Holder(Print): State Certification/Registration W-4 ri� Notarized Signature of License Holder o 20 Sworn and sub bed ore e this-f\ Signature of Notary Pu