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/
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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
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