Permit Sewer/Plbg 1671 Beach 2011 o
6 CITY OF ATLANTIC BEACH
.° , . 800 SEMINOLE ROAD
j #4 ' ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
Application Number 11- 00001994 Date 4/27/11
Property Address 1671 BEACH AVE
Application type description Z -ADV PMT -SEWER IMPACT FEE
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
SEWER FEES
Owner Contractor
GAY OWNER
1671 BEACH AVENUE
ATLANTIC BEACH FL 32233
Permit ADV PMT -SEWER IMPACT FEE
Additional desc . SEWER FEE
Permit Fee . . . .00 Plan Check Fee . . .00
Issue Date . . . 4/27/11 Valuation . . . . 0
Expiration Date . 4/27/11
Other Fees SEWER SDC- SYSTEM DEV CHG 4050.00
Fee summary Charged Paid Credited Due
Permit Fee Total .00 .00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4050.00 4050.00 .00 .00
Grand Total 4050.00 4050.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
0Lli,rt Ja
/ `, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
t:)11, �^ ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
JJ319
Application Number 11- 00001995 Date 4/27/11
Property Address 1671 BEACH AVE
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
CONNECT TO CITY SEWER
Owner Contractor
GAY TERRY VEREEN PLUMBING
1671 BEACH AVENUE 2934 POST STREET
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32205
(904) 384 -5661
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 10/24/11
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: 9/ fiatsvV PERMIT #
■EW 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
VIISCELLANEOUS:
ewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
Lawn Sprinkler System - Number of Heads ❑ Well **
c* SJRWD W 11 Completion Form. Completed form to be sub itted to the Build'ng Department for final inspection. **
Cher Z <� P� —�'� /4/104,-. - '<
'ermit 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
his 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 v ate the provisions of any other state or local law regulation construction or the performance of construction.
'roperty Owners Name &fr'r 1 Phone Number z49 — 4-3
) 110
numbing Company . ` r2 i :- Office Phone Fax3� c 4 2
- 2o. Address: 7 34 ?D 7 3 City , .),C- State /L Zip 22
License Holder (Print): L° Y e 1' ee t'` Sta a ification/Registration # /� 253 Y 7
Notarized Signature of License Holder Z,V
NOTARY PUBLIC -STATE OF FLORIDA Sworn and subscribed befo( - this r,:V ‘- day of A' ` 20 1/
Jean H. Edwards
r Cornraiagtltt #1a1)821008 Signature of Notary Public , ' �a
.,,,,, Expire DEC, 15, 2012
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