Permit Plbg Repipe 555 Selva Lakes Cir 2011 ij-V1
,' ` ‘ CITY OF ATLANTIC BEACH
'� �� 800 SEMINOLE ROAD
.0 =" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
lMN v
Application Number 11- 00001810 Date 3/21/11
Property Address 555 SELVA LAKES CIR
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
REPIPE
Owner Contractor
CLAYTON THEODORE ET AL TDG PLUMBING
555 SEVLA LAKES CIR. 4426 LOYS DRIVE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32246
(904) 545 -7341
Permit PLUMBING PERMIT
Additional desc . REPIPE 14 FIXTURES
Permit Fee . . . 153.00 Plan Check Fee .00
Issue Date Valuation . 0
Expiration Date . . 9/17/11
Other Fees STATE PLBG DCA SURCHARGE 2.30
STATE PLBG DBPR SURCHARGE 2.30
Fee summary Charged Paid Credited Due
Permit Fee Total 153.00 153.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.60 4.60 .00 .00
Grand Total 157.60 157.60 .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: .6 "-- S - S -- Se )(1/9 L/9,te C .,.c1 PERMIT # //7 f7 0
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
-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE
QTY
Bathtub / Septic Tank & Pit
Clothes Washer
Shower _i
Dishwasher / Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 3
Hose Bibs 2 Urinal
Kitchen Sink F Vacuum Breakers AI
Laundry Tray Water Connected Appliances
Lavator L I t 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 violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners NameTjJ C L ,'r/7o ti Phone Number
Plumbing Company 1T . C e L,r` b ,•, N' i C Office Phone s - 7311/ Fax S - (?SY
Co. Address: " T 4), (, L ( D (t City Y '91F State FL Zip 3 2 ( 1f:
License Holder (Print): r : ;S 0 . , ; 4 Q State Certificatio gistration # f, F Q-- 2770( 2_
Notar'_ •. •_ o License Holder
r: MY I a 4126 worn and s u bscribed before this
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t eons d X rn R eMP b l� 011 e� I ignature of Notary Public , • -i4 --- 1