Permit Plbg 212 Magnolia 2011 6 - `S „ CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
' ATLANTIC BEACH, FL 32233
;" ` INSPECTION PHONE LINE 247 -5814
Application Number . . . . . 11- 00002092 Date 5/17/11
Property Address 212 MAGNOLIA ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
14 fixtures
Owner Contractor
DALCERO, RICHARD STEEG PLUMBING CO., INC.
P.O.BOX 330536
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 249 -5191
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 153.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 11/13/11
Other Fees STATE PLBG DCA SURCHARGE 2.30
STATE PLBG DBPR SURCHARGE 2.30
Fee summary Charged Paid Credited Due
Permit Fee Total 153.00 153.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.60 4.60 .00 .00
Grand Total 157.60 157.60 .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: - ,2/01 ivy 4,5 1/w PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QrY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
Slop Sink
D�ra�ounta�n 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 1 Shower Pan
Slop ink
Floor Drain Three Three Compartment Sink
Floor Sink Toilet
Hose Bibs _. 1- Urinal
Kitchen Sink / Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer 0 Grease Interceptor (Trap) gallons (Requires 3 sets of plan
❑ Lawn Sprinkler System - Number of Heads D 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 wor is suspended or abandoned for six months. I hereby certify that I have rc
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 specific
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 y-"y 49 r Ai o Phone Number
Plumbing Company : ph e, „"7`L Office Phone a ?115i4/ Fax a0
Co. Address: /49) Rohl 51 City # ` State Zip Z*
j fti State Certification/Registration License Holder (Print): , �9�
Notarized Signature of License Hold er _ °_ . 1 i� .� tit. 1� .. .
. i 4e ate ` .. 'A al e , us (7 • . •, 20 J
W... 3: • 4 71 , EXPIRES: February a 2Dt4 � .
•