Permit Plbg 1822 Hickory Ln 2011 V ` s CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J `" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
4r1.;3!
Application Number 11- 00001850 Date 3/29/11
Property Address 1822 HICKORY LN
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
13 fixtures
Owner Contractor
ADHIKARI LARRY TEAGUE & SONS
1822 HICKORY LANE 203 OCEANFRONT
ATLANTIC BEACH FL 32233 NEPTUNE BEACH FL 32266
(904) 270 -2289
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 146.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 9/25/11
Other Fees STATE PLBG DCA SURCHARGE 2.19
STATE PLBG DBPR SURCHARGE 2.19
Fee summary Charged Paid Credited Due
Permit Fee Total 146.00 146.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.38 4.38 .00 .00
Grand Total 150.38 150.38 .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: r gz I-f r c1<D Re L.4iv . 32 33 PERMIT #
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
RE -PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub ___l____ Septic Tank & Pit
Clothes Washer _4_ Shower __i
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 --i_
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 1 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 Name Ic -5 h1km 44 hi, ktftiel Phone Number 2..0•3 l,6
Plumbing Company l JL 7934.4UE PLOAB /NC- Office Phone 210 • ” Fax 2.4-9.8W?
Co. Address: 3 OC WF T Cit A/5 /v6 014' State FL-zip 324A
License Holder (Print): Ai(NQw 6-. _.. / State Certificaf , n/Registration # CFee .2621
1 '
Notarized Signature of License Holder •._
Sworn and subscribed before m this S day of AMITO 20 1/
$5"t Notary Public State of Florida
Iff ?1' ` ' Lin E Maple �^
My Commission DD850194 Signature of Notary Public 6. i„afca..-
? Expires 01 /08/2013