Permit Plbg Water htr 1717 Selva Marina Dr 2011 `0.-Sl `11!
, . I . CITY OF ATLANTIC BE RO
� I . 800 SEMINOLE
. ATLANTIC BEACH, FL 32233
=" INSPECTION PHONE LINE 247 -5826
` jii5 ' r
Date 3/15/11
Property . i1- 00001797 MARINA DR
App Ad Address Number . . 1717 SELVA MAR
perty Ad ONLY
Application type description PLUMBING PLUMBING OUPDANLNLD
Property Zoning
0 - - - --
Application _ valu ation ----- ------------- --------------------- - - - - --
----- Application desc -------------------------
1 fixture ----------------------------------
------- - - - - --
Owner Contractor --- __ -_ - - -_
_
------ ---- - - - - -- F.W. FAIR PLUMBING CO.
MORGAN, NORMAN D. P.O. DRAWER 51558 FL 32250
ATLANTIC TIC SELVA BEACH MARINA DR. FL 32233 JAX BEACH
ATLANTIC BEACH -------- - - - --( 904 )_241_7191------------- ____ --
- -_- _ __
. . . . . ._- PLUMBING PERMIT .00
Additional desc • 82.00 Plan Check Fee 0
Permit Fee Valuation
Issue Date 9/11/11 ------------------------ •
Expiration Date
__ •------------------------ - - - - -- 2.00
Other Fees . STATE PLBG DCA SURCHARGE 2.00
Other Fees STATE PLBG DBPR SURCHARGE -- _______
------ ------------- - - - - -- - Credited
----------------- - - - - -- Paid
Charged ---- -ue - --
Fee summary ---- - - - - -- ---- - - - - -- ---- - -_.00 .00
_ ---- - - - - -- 62.00 62.00 .00 .00
Permit Fee Total .00 .00 .00
Plan Check Total 4.00 .00
4.00
Other Fee Total 66.00 66.00 0 0 .00
Grand Total
AUK DI NG CODES. ,(� O�
K OE�zovED ONLY IN ACCORDANCE
BUIL WITH ALL CITY OF ATLANTIC ��A(j
1N ANCE
0 40 I,
11#
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 -5845
JOB ADDRESS:
7 I ? ) < k'G I �,Ori. r, �� PERNIIT Al (1 - ill
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 Dram 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 Dram 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 final 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 vi to the provisions of any other state or local law regulation construction or the performance of construction.
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Property Owners Name E A ('�' Phone Number.? 6 7 Y
Plumbing Company W Al ill) Office Phoned Y! 7 i q Fax V/- 4723
Co. Address:
6 flrSr _ it T State Zip J2Z 16
License Holder (Print): rat, E i
1 ....,,-
w l iu , /� •t-, ertification/Registration # PF 6 0 ,3 7 J &
Notarized Signature of License Holder #1�.� ` ►,a.
Ni I SH • - ff.. • --
Sworn and subscribed befo►; `,, ► MYco u ► 20
Signature of Notary Public ' = a + ° _�_
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