Permit Plbg Water Heater 2016 Selva Madera 2011 4L f J ��
CITY OF ATLANTIC BEACH
-;.' r) 800 SEMINOLE ROAD
` " ' , ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002529 Date 8/22/11
Property Address 2016 SELVA MADERA CT
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
1 FIXTURE
Owner Contractor
GREENWALD, JOHN ATLANTIC COAST PLUMBING CORP.
2016 SELVA MADERA CT. 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 . 2/18/12
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 22 11 06:25p Susan Parrish 904 -246 -3673
p. 1
•
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
• S00. Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 -5845
JOB AD DRESS: 9 Sli/ /9? /9.ietiq PERMIT #
NEW a REPLACEMEI INSTALLATION: Project Value s _
TYPE OF FIXTURE QTY TYPE OFFIXTURE QTY
Bathtub Septic Tank & Pit
Clothes washer Shower
Dishwasher Shower Pan
Dg 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 OFFLICTURE 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 Bbs _ Urinal Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS: .
•
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Crease Interceptor (Trap) _ gallons (Requires 3 sets of plans)
o Lawn Sprinkler System - Number of Heads 0 Well **
** SJR WD Well Completion Form. Completed formic be submitted to the Building Department far 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 of construction.
Property Owners Name cJ ;A ' ( r y1 i, J� 4/ J Phone Number 2 i 2 - 45? f
Plumbing Company /4f /4 /dG. e X35 Koh p � r
y� / Office Phone 9f7-3,278 Fax 'XS: 95 Co. Address: 3g�3 4�r>'n 7 14-i 1 City Of ,� ,,,.,��//�
i tY State Zip .3,�?
License Holder (Print): / ,,4 o ,
' ?Ailiii; =— - ; , . 'on/Registration # eA=L�'o . <9...9.67 Notarized Signature oat Holder 1 ,, 4
-
Sworn and subscribed before me . ' . IVi i : x,,. . , , ., . a
y
Signature of Notary Public f , �. eta Public • Stite of Florida
y';. �� Commn UO9laf
or r ;,,a tionosd rnrougn issio n nation # ai DD
ifteary Assn.
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