Permit Plbg New Water svc 2061 Beach 2011 �� CITY OF ATLANTIC BEACH
.� : l 800 SEMINOLE ROAD
- ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
I- .0135
Application Number 11- 00002357 Date 7/18/11
Property Address 2061 BEACH AVE
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
RUN NEW WATER SERVICE FEES PAID #11 -2318
Owner Contractor
SHAW CHRISTY FIRST COAST PLUMBING
2061 BEACH AVENUE 1651 MAYPORT RD
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 247 -4419
Permit PLUMBING PERMIT
Additional desc . NEW WATER SEWER
Permit Fee . . . 62.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 1/14/12
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.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 -5845
JOB ADDRESS: 919 ( c ` - :'�`� ` a fLLL-L PERMIT # / - 2 3 S .
NEW OR REPLACEMENT INSTALLATION: Project Value $ •
.
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 Fixtures Water Treating System
RE PIPE:
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 Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Lawn Sprinkler System Number of Heads ❑ Well **
** SIRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection. **
V Other 11) d
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 provisions of any other state of local law regulation construction or the performance of construction.
Property Owners Name ..61-1-Aur Phone Number 0 - D OA-
Plumbing Company CH 5t`( II (,DA PLWT 7 Office Phone 6141 , Fax ?4 q -''.6 ov
Co. Address: it, 51 M C4 O (f �CLcL Cit !-W �a()h C beaClState Tt Zip 3c a 3
License Holder (Print): A r , ( � �. S Certification/Registration #
Notarized Signature of License : o ' r 1 Ayi e1 J
,,, , Sworn and subs�� ed before me this / 1/
y of ei 20
, ytiM"' JULIE YL YNG CHRISTY / '1.81t
:.: !! . MY COMMISSION # DD 873293 Signature of Notary Public 4 ` / '
EXPIRES: July 21, 2013
Rf Bonded Thtu Notary Public UrMenrtitera
BP821U01 CITY OF ATLANTIC BEACH 7/18/11
Application Fees Maintenance 12:36:00
Application number . .'��':
Address : 2061 BEACH AVE
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Amount Previously
Opt To Apply Description Applied u`
4050.00 SEWER SDC- SYSTEM DEV CHG .00 .00
_ WATER CONNECT /METER ONLY .00 Off,
_ WATER CONNECT /TAP & METER 710.00
WATER CROSS CONNECTION 50.00
SDC- SYSTEM DEV CHG 1140.00
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