Permit Plbg 125 Fleet Landing 125 w ''' r CITY OF ATLANTIC BEACH
' 800 SEMINOLE ROAD
� C) � � ATLANTIC BEACH, FL
32233
INSPECTION PHONE LINE 247 -5814
. ' " •01.11%}
Application Number 11- 00002310 Date 7/07/11
Property Address 125 FLEET LANDING BLVD
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
1 FIXTURE
Owner Contractor
NAVAL CONTINUING CARE DAVID GRAY PLUMBING INC.
RETIREMENT FOUNDATION, INC 8850 CORPORATE SQUARE CT.
1 FLEET LANDING BLVD JACKSONVILLE FL 32216
ATLANTIC BEACH FL 322334599 (904) 744 -7255
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date . . 1/03/12
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.
Iv Icy vU Ill I 4.. ogp Intormation SystemsCfTY 0
904- 247 -5845 p.1
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-826 Fax (904) 247 -5845
JOB ADDRESS: / ei&t 444 I ' fl" C
i PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE
Bathtub QTY
Clothes Washer Septic Tank & Pit
Disirvvasher Shower
Drinking Fountain Shower Pan
Slap Sink
Floor Drain
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Vacuum Breakers
Laundry Tray
Lavatory Water Connected Appliances
Other Fixtures Water Heater �—
Water Treating System
RE-PIPE;
•
TYPE OF FIXTURE QTY TYPE OF FIXTURE
Bathtub Qom'
Clothes Washer Septic Tank & Pit
Dishwasher Shower
Shower Pan
Drinking Fountain --
Slop Sink
Floor Drain
Floor Sink
Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Vacuum Breakers
Laundry Sink
Lavatory Water Connected Appliances
Fixtures Other Water Heater
Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Presenter 0 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. **
D 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 ()flaws and ordinances governing this work will be complied with whether specified
or not The permit does not give authority . % ate a pro, •ons f any other. state or local law regulation construction or the
oca performance of construction.
Property Owners Name Phone Number 15' �' Plumbing Company ` r�Y Plumbi 1 c.
8850 Corporate Square Nut l Office Phone 7 , 7Z.4 Fax DJ-3
Co. Address: Jacksonville, Hnrida 32216 City State Zip
License Holder (Print): PIPIO 4:: 44giti State Certification/Registration # C/Y dZX3 - d 4
Notarized Signature of License Holder PrAvul 1}
/
-jil
Sworn and subscribed before me this , day of t r '
Signature of Notary Public - / 1/ 2 ,, , - Ai
/ uar Notary Public State of Florida
f Neat R Major
S c . My ComioE032510
for no Expires 12/20miss/2014 n E