Permit Plbg Shower Pan 566 Plaza 2011 J '� f, CITY OF ATLANTIC BEACH
,. 800 SEMINOLE ROAD
a , -r ATLANTIC BEACH, FL 32233
_ t INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002511 Date 8/18/11
Property Address 566 PLAZA
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
1 fixture
Owner Contractor
HEINE ATLANTIC COAST PLUMBING CORP.
566 PLAZA 3653 REGENT BLVD #305
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32224
(904) 249 -5381
Permit PLUMBING PERMIT
Additional desc .
Permit Fee 62.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 2/14/12
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.
Aug 18 11 12:40p Susan Parrish 904 -246 -3673 p•1
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800.Seminole Rd Atlantic Beach, FL 32233
• �
j Ph (9(04) 247 -5826 Fax (904 247 -5845
JOB ADDRESS: ✓ 7LC PERMIT #
NEW co frPLACEME ' 1 STALLATION: Project Value $
► r r • Qrr TYPE OFFIXTT/RE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Dram 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
11E-PIPE:
TAE 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: •
o Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plane)
❑ Lawn Sprinkler System - Number of Heads 0 Well **
** SIRWD WeII Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other
Permit becomes void if work does riot commence — within asix month period or work is suspended or abandoned for six months. I hereby certify that I buve read
this application and know the same to be true nod correct Alt provisoes of laws and ordinances governing this work will be complied with whether specified
or not The permit does not give authority to violate the p isians of any other state or local law regulation construction or the performance of construction.
Property Owners Name 1 414 = 1,4 6 Phone Number , 54 / ' 44
Plumbing Company A vvrt e- 0)4. -S r' — 15 • office Phone ?Q7 -3Z 7g" Fax e ?c3 63
Co. Address: 3 6 53 - R c"E r 72 t- 0 ) 0 065 City <J A . State 6 .- - Zip .'f 7 ' 7 Z
License Holder (Print): • A — P State Certificate egistration # e re 0
Notarized Signature of License Holder 1
Sworn and subscribed before me th 0 4 ‘ '1 ; vme . - - • ' ' r
N Public - State of Florida
Signature of Notary Public
A� �� " . . 4 , ' y,. -
s " 7u•- ' Commission 0 DD 880918 O
g Bonded Through National Notary Assn.
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