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Permit Plbg 1236 Main 2011 CITY OF ATLANTIC BEACH -Iv A. 800 SEMINOLE ROAD j ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00002405 Date 7/29/11 Property Address 1236 MAIN ST Application type description PLUMBING ONLY Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc 8 fixtures Owner Contractor HERNANDEZ HARTLEY SERVICE INC 12673 JULINGTON CREEK PINES LN ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32223 (904) 382 -3369 Permit PLUMBING PERMIT Additional desc . Permit Fee . . . 111.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 1/25/12 Other Fees STATE PLBG DCA SURCHARGE 2.00 STATE PLBG DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 111.00 111.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 115.00 115.00 .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 ,f / PERMIT # JOB ADDRESS: /,=' 3 .- /V(- t!.(�tti, NEW OR REPLACEMENT INSTALLATION: Project Value $ -: U 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 Fix es , ' ® ) Water Treating System RE -PIP . C / TYPE 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 V 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 ** ** 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 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 io .te the provisions of any other state or local law regulation construction or the performance of construction. Property Owners N. Art 0 6 - Phone Number Plumbing Company ( Office Phone 36 2 3 3k 2Fax Co. Address: City State Zip License Holder (Print): : 4;: <� 1 . ,i / , / : - - ' • c ation/Registration # ,/ Notarized Sig, : ---% .- ----` , � ;; _ a �9' yw lm ___ _ L ki / /' '& i ` rs to cows: a 21, 2015 - / r " 1 0 M putg : ' e1'r efs • subscribed befor- e t� s da f • 20 // yl '.4 - sonderrh N -- , -� / Signatu of Notary P i -e--0 4' /UbC� (.94,-)c=1-3-2/ b 3`rL g 0 PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247 - 5826 Fax (904) 247 -5845 JOB ADDRESS: 1 2069 )flfail) S • A/1AM C.-X`/ ' 3 a Q .33 PERMIT # NEW OR REPLACEMENT INSTALLATION: Project Value $ .3 $CO •a7 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 — 1 Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Hose Bibs Urinal Kitchen Sink — L— Vacuum Breakers Laund or Tray 1 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 PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 JOB ADDRESS: 12„ (..G? in l A ZQ() -ST, Paitilic.,17 3 a a,33 PERMIT # . 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 goveming 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 J VH 64;--t 677, Phone Number ?j 3 - , Y('y Plumbing Company I yA- 47 „5" t)( (6i -/A)C, Office Phone W" 3 k) - 33 fic Co. Address: / 93 J (J/ /1) &7 Z) P, /C_1 / it) City a 3 9t /ZState FL Zip 3a.2a3 • License Holder (Print): _ IP ' I t_114-4 S� to Certification/Registration # 1 l- //O673�, j Notarized Signature of License Holder 1l4 . 1 1 ) AS t) Sworn and subscribed before me this day of 20 Signature of Notary Public 0 /7 5 G e // . Q - - 7' - - - e- - 7 - - t - _ . . , • ,