Permit Plbg Septic to Sewer 632 Camelia 2011 4 r rl
iirrAw: CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
{t.y' ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
' 4Ji319'
Application Number . . . . . 11- 00002156 Date 6/01/11
Property Address 632 CAMELIA ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
CONNECT TO CITY SEWER
Owner Contractor
LONG, EUGENE & MARY ADVANTAGE PLUMBING
632 CAMELIA STREET 880 MAYPORT RD
ATLANTIC BEACH FL 32233 -252 ATLANTIC BEACH FL 32233
(904) 247 -9848
Permit PLUMBING PERMIT
Additional desc . SEPTIC TO SEWER CONNECTION
Permit Fee . . . 62.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 11/28/11
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.
Jun 01 11 07:21a Christy First Coast Plumb 9042494660 p.1
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH AY,
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 -5845 I n
JOB ADDRESS: ‘6 3(A ( /Y � �., Stre, I' RMIT # (� Z 1 J'O
NEW OR REPLACEMENT INSTALLATION: Project Value $ .
TYPE OF FIXTURE QTY TYPE OF FIXTURE Qry /
Bathtub Septic Tank & Pit
C
kr
lothes 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 VA
Lavatory Water Heater
Other Fixtures Water Treating System '�'
�
l �
RE PIPE: ,.t 9
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 Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer 0 Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Lawn Sprinlder System Number of Heads 0 Well **
** SJRWD We 1 Completion Form. Completed form to be submitted to the Building Department for final inspection. **
i I a ther ML. &led hr AttA.
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 2 if (/ h'` • �f.'.19 Phone Number ,.5 - 7 /l .
C o m p a n y Plumbing J(1 r1? 13i a4c Office Phone 4; ;2(7 1 7 .-- 9� `J6 Fax o? �l7 -?g 1 -1 J
Co. Address: SgO ✓� r jf & c' . City ,�TI ' '3c--- State Zip
License Holder (Print): ..... ' 4 State r ; , : i cation/Registration # eFCHC
Notarized Signature of License Holder - lee_ ,, 11 , , _ •
Sworn and subscri before me this 4 . I of 3 - - . 20 1 I
• :i "'l" MICHELLE L CREWS ' ` 1 Re 1 I . �1i
"` MY COMMISSION # EE037670 S of Notary Publ ,. • —
. "'t,4', EXPIRES October 26, 2014
(407) 39 -0153 FloridallotaryService.com