Permit Sewer 851 Main Only 2011 `r , /r,1.
mil ,,,
s CITY OF ATLANTIC BEACH
*" s) 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
`y V 3rd9
(�� )){ INSPECTION PHONE LINE 247 -5826
Application Number 11- 00001970 Date 4/22/11
Property Address 851 MAIN ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
SEWER REPLACEMENT
Owner Contractor
SAPIA ROLLAND REASH PLUMBING .
851 MAIN STREET 11501 W COLUMBIA PARK DR #208
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32258
(904) 260 -7059
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 10/19/11
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 62.00 62.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 66.00 66.00 .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: s g s 5/ (l/l .5T 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 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
MISCELLANEOUS:
Sewer Replacement LI Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Lawn Sprinkler System- Number of Heads i 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. 1 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 i3 " r 5"- / ' I Phone Number 3 04/ -696,
O
Plumbing Company /tail ,u.0 Re Pt Phone a`, 0 - - 7052 Fax..? 4 b - 07/1
Co. Address: /15-0/ £ /:4 ,'4 j the ,Rei(/ a Cit Tit State re- Zip 30125$
License Holder (Print): ROLL/PU/ _ et .tate ific 'on/Registration # F 652/7/
Notarized Signature of License Holder /�
Sworn and subscribed before me this al sT day of r4P21L 20 11
ei Notary Public State of Florida
• r Paul R Bagby (� J
� � My Commission EE Signature of Notary Public T t�
or r�o Expvea 01/23/2015 042408 Cr
BP200I01 CITY OF ATLANTIC BEACH 4/22/11
Application Inquiry 10:15:57
Application number : 08 00001541
Application status, date . : CLOSED 6/01/09
Property : 851 MAIN ST
RE number. : 170944 -0010- -
NCR OLD ACCOUNT NUMBERS. . : AB12358
Zoning : TBU TO BE UPDATED
Application type : ADSW Z -ADV PMT - SEWER IMPACT FEE
Application date : 11/19/08
Tenant number, name . . . :
Master plan number, rev'wd by: SLG
Estimated valuation . . . . :
Total square footage . . . : 0
Public building : NO
Work description, qty . . :
Pin number : 113482
Application desc : SEWER IMPACT
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