Permit Plbg 331 19th St 2011 sr�� 1"
' CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
= ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002100 Date 5/17/11
Property Address 331 19TH ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
12 FIXTURES
Owner Contractor
CRUMPLER LARRY TEAGUE & SONS
331 19TH STREET 203 OCEANFRONT
ATLANTIC BEACH FL 32233 NEPTUNE BEACH FL 32266
(904) 270 -2289
Permit PLUMBING PERMIT
Additional desc .
Permit Fee • • • • 139.00 Plan Check Fee . . .00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 11/13/11
Other Fees STATE PLBG DCA SURCHARGE 2.09
STATE PLBG DBPR SURCHARGE 2.09
Fee summary Charged Paid Credited Due
Permit Fee Total 139.00 139.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.18 4.18 .00 .00
Grand Total 143.18 143.18 .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
l Ph (904) 247 -5826 Fax (904) 247 -5845
JOB ADDRESS: 35 i i l Q +h - -c,e PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE Q TY
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 1 Septic Tank & Pit
Clothes Washer 1 Shower — 1 —
Dishwasher __1---_ Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 2,
Hose Bibs 2. Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 2.. Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS: 0
❑ 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 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 p ovisions of an other state or local law regulation construction or the performance of construction.
Property Owners Name J (VMS UM 0 Phone Number 4 66441 '
Plumbing Company LL rr ' t _ d ' Al 0 i b cffice Phone 10-2- ci Faxes- -- bZ9
Co. Address: 1 0MM:t it Pity City ktepFona Ti Zi
License Holder (Print): i 1 / � .� / ' g State Certification/Registration # 02,1 5 P8
Notarized Signature of License Holder _CtheiZfille■eve—tr
Sworn and subscribed before m this ) t "day of / Ay 20
r d'' y Nit Notary Public State of Florida `
Lin E Maple Signature of Notary Public
o My Commission DD850194
91oivoa Expires 01/08/2013