Permit Plbg Replace Sewer 1757 W Park Ter 2011 ' . J CITY OF ATLANTIC BEACH
, � r) 800 SEMINOLE ROAD
.
J X ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002679 Date 9/26/11
Property Address 1757 W PARK TER
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
SEPTIC TO SEWER
Owner Contractor
GODFREY, C. H. CHRISTY FIRST COAST PLUMBING
1757 PARK TERRACE WEST 1651 MAYPORT RD
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 247 -4419
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date . . 3/24/12
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
PERNIIT 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
ADDRESS: I v P t?JR . - rem -, CL We, PER nT #
NEW OR REPLACEMENT INSTALLATION: Project Value $ •
TYPE OFFIXTURE 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 OFFIXTURE 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 Fixtiues Water Treating System
CELLANEOUS:
S ewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
o Lawn Sprinkler System Number of Heads 0 Well **
** SIRWD Well Completion Form. Completed foam to be submitted to the Building Department for final inspection. **
o Other
■
Permit becomes void if work does not commence within a six month od or work is
pert 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 rity to violate the provisions of any other §tale or local law regulation construction or the performance of construction
Property Owners Name �£ Qdq Phone �� jj " one Number G��o — ( 0 f�
Plumbing Company (! H r.-t 5 1 - V ' fi f CV �I1 ' ce Phone 6Z4 q Fax ,4 q - 4-ko&v
Co. Address: 1(4) 51 1401 0,I ( A- OCL.C& / Cit f k jC((}h•C. b &CiChState ` -- Z ip 3a 3
License Holder (Print): , 4A ,_ , — _ �� State Certification/Registration # ��/ Cif •• t
Notarized Signature of License : olde " • C// K. 4*UI
' ;' ,nuEVansrn worn and subscribed before me this day of — 20 /I
TA MY COMMISSION DD 873293
, � llt 14 EXPIRES: July 21, 2013 1 Sig nature o Notary Pubi 4, i,/� It_..," � / A
o� Bonded Tint Noisy Public Undenxrkers �.
•