Permit Plbg Repipe 1142 Hibiscus 2011 S rM 0
CITY OF ATLANTIC BEACH
%` 800 SEMINOLE ROAD
j °° ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number . . . . . 11- 00002388 Date 7/25/11
Property Address 1142 HIBISCUS ST
Application type description PLUMBING ONLY
Property Zoning RES SF DISTRICT
Application valuation . . . 1900
Application desc
REPIPE 11 FIXTURES
Owner Contractor
MYERS ANNETTE CHRISTY FIRST COAST PLUMBING
1142 HIBISCUS STREET 1651 MAYPORT RD
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 247 -4419
Permit PLUMBING PERMIT
Additional desc . REPIPE
Permit Fee . . . 132.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 1/21/12
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 132.00 132.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 136.00 136.00 .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
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JOBADDRESS: // , l ibse 4 5 Stre et PERNIIT#
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NEW OR REPLACEMENT INSTALLATION: Project Value $ /9D0 , 00 - .
TYPE OFFIXTURE QTY TYPE OFFIXTURE QTY
Bathtub of Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet g
Hose Bibs g✓ Urinal
Kitchen Sink / Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 8., Water Heater
Other Fixtures Water Treating System
RE -PIPE:
TYPE OF FIXTURE QTY TYPE OFFIXTURE 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. **
❑ 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 provisions of any other State or local law regulation construction or the performance
/} mance of construction.
Property Owners Name ,L%C ni e/S Phone Number `/(;'? . "� 7
Plumbing Company OEH P-t 51 1'I I� CV( PL LUnb l ce Phone 6Z 1 `1 44 l q Fax di4 q Ob(7
Co. Address: It" 51 4 Uf O n RACLC& City Atlantic beactiState `4L Zip 5 3
License Holder (Print): 1 7,4I up ,. .1 ! Stat - ; I cation/Registration #
Notarized Signature of License older �i
L r" • . -- - t=
worn and sub' ' • : , - fore me this day of P � / / 20 //
I l / 4 MY COMMISSION ii DD 873293 it' /
. EXPIRES auty 21, tots • ignature o f Notary Publi ,G{. ' 9a,ded Thru Pmr" PuhNc u ndenvrlten