Permit Plbg #001 2233 Seminole 2011 ", ' ` CITY OF ATLANTIC BEACH
' . . ' 0 800 SEMINOLE ROAD
°p .� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002648 Date 9/20/11
Property Address 2233 SEMINOLE RD UNIT 001
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
1 fixture
Owner Contractor
WRIGHT, WILLARD STEEG PLUMBING
2233 SEMINOLE #001 1601 MAIN STREET
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 249 -5191
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 3/18/12
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.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
806 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247-5845
c A
JOB ADDRESS: " 3 3 I .,, . ' iate PERmrr #
NEW OR REPLACEMENT INSTALLATION: Project Value
TYPE OF FIXTURE OTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower __L_
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 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 pi:
❑ Lawn Sprinkler System - Number of Heads ❑ Well **
X SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspectioi
❑ 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
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 speci
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 constructi
Property Owners Name 0/{ r g-t-- Phone Number
Plumbing Company S7 c �/bf ( �r Office Phone , 5'l9) Fax g
Co. Address: /GD) /gel ^ 57 City .4 he-` Statell State / Zip3Z16r
License Rob • ' got' , , „,, L... State Certification/Registration /'os
5
Alli
'ed _''
Sworn and ..scribed before le = s day Of ' 11 ' 'Of fry
Signature of Notary Public i '