Permit Plbg to Sewer 1987 Beach 2011 , s ,..fi CITY OF ATLANTIC BEACH
,r4 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
' 0
Application Number 11- 00001997 Date 4/27/11
Property Address 1987 BEACH AVE
Application type description PLUMBING ONLY
Property Zoning RES SF DISTRICT
Application valuation . 0
Application desc
SEWER HOOKUP PAID IMPACT FEE 08 1483
Owner Contractor
SCOTT, WILLIAM W. ATLANTIC COAST PLUMBING CORP.
1987 BEACH AVENUE 3653 REGENT BLVD #305
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32224
(904) 249 -5381
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 U
$00 Seminole Rd Atlantic Beach, FL 32233 O
Ph (904) 247 -5826 Fax (904) 247 -5845
J O B ADDRESS: /9g7 ( � .) C A& 4 /4‘)-- PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OFFLXCTQRE QTY TYPE OFFEMME QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
D onn Drain Three Slop Sink
Floor Dam Toilet
p t Sink
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laval Tray Water Heater Appliances
Postures Water Treating System
RE -PIPE:
TYPE OFFEMME QTY TYPE OFFIXTURE QTY
•
Bathtub Septic Tank Be Pit
Clothes Washer Shower
Dishwasher
Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs .
Kitchen Sink Vacuum Breakers
Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MJSCELLANEOUS: •
S ewer Replacement o Back Flow Preventer 0 Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
o Lawn Sprinkler System - Number of Heads 0 Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
o 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 envisions of
p any other stabs or lienl law regulation construction or the perfomowe of consarctioa.
Property Owners Name �tL / / ..) 0 � Phone Number 2 ti 3 �Z - /3
Plumbing Company A 7 - r) r !' i °r ? L v at 57/v4 Office Phone 9 q 7 -5 Z 7ff'Fax d (15 S3 (c .3
Co. Address: 3 b 5 3 - R6 �'O * ACS' City -i ce < 4 SO 4 7� State T zip $22 7 -V
License Holder (Print): . ,(� - ; 1 ., ... _.... _.._ Certification/Registration# (''(iC5t59G
f ri
Notarized Signature ofLicense Holder 7/11.1,'i 7 Sworn and subscribed before me i 2 / day of A ' / L 20/
Signature of Notary Public /,,1 . £ 0:I, o. aoct�E
�� '� 's Notary Public • State of Florida
, • + • s My Comm. Expires Apr 15. 2019
�; Commission 0 DD X11
. ` Bonded Nonni' National Notary Assn.