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
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Application desc
10 fixtures
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Owner Contractor
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STEELE, ALI DELANEY STEEG PLUMBING
230 LORA STREET 1601 MAIN STREET
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 249-5191
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 125 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 8/09/11
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Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
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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