Permit Plbg 5414 Capella 2011 v.
'~ CITY OF ATLANTIC BEACH
`a�'' 800 SEMINOLE ROAD
0 70- ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
Application Number 11- 00001910 Date 4/11/11
Property Address 5414 CAPELLA CT
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
9 fixtures
Owner Contractor
NAVAL CONTINUING CARE DAVID GRAY PLUMBING INC.
RETIREMENT FOUNDATION, INC 8850 CORPORATE SQUARE CT.
1 FLEET LANDING BLVD JACKSONVILLE FL 32216
ATLANTIC BEACH FL 322334599 (904) 744 -7255
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 118.00 Plan Check Fee .00
Issue Date Valuation . . . . 0
Expiration Date . . 10/08/11
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 118.00 118.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 122.00 122.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Mar 08 10 12:54p Information SystemsCJTY 0
904- 247 -5845 p ,1
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 -5845
J013 ADDRESS: � 1' C /Pfd (' 0 fZ i PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OFFrATURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower
- Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet p
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 QTR' TYPE OF FARE QTY
Bathtub / Septic Tank & Pit
Clothes Washer Shower i
Dishwasher T Shower Pan
Drinking Fountain _ . . Slop Sink ('�
Floor Drain Three Compartment Sink " I
Floor Sink Toilet
Hose Bibs Urinal Z
Kitchen Sink i Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 1-- Water Heater ___L
Fixtures / Water Treating System
MISCELLANEOUS: V
❑ Sewer Replacement ❑ Back Flow Presenter ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of Maus)
❑ Lawn Sprinkler System Number of Heads ❑ WeIl **
** 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 Name /g6f Mi1CP/i K Phone Number 14 6 - y ?II
Plumbing Company D id Gray Plumbing, Inc. :+: i • ... : _ • , . - -. Office Phone 7 .9 <� Fax 7-;2-3.-.5
Co. Address: ,l rii li3 Rnrid_n 1f, Cit State Zip
F
License Holder (Print): f) io � 4 ^j2m'' State Certification/Registration # C/ 1 DZ2 4 6
Notarized Signature of License Holder 19414;1 t i
Sworn and subscribed before me 's i ' day of 20 / /
Signature of Notary Public
r Y "oe Notary is State of Florida
1 Neal ^ ajor
P c. a` My Co fission EE032510
� ol/_o Expires 12/20/2014