Permit Plbg Septic to Sewer 995 Camelia 2011 CITY OF ATLANTIC BEACH
1 s) 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002711 Date 9/30/11
Property Address 995 CAMELIA ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
septic to sewer
Owner Contractor
PILLMORE, PAT DAVID GRAY PLUMBING INC.
995 CAMELIA STREET 8850 CORPORATE SQUARE CT.
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32216
(904) 744 -7255
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 3/28/12
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.
Me.r 08 10 12:54p information SystemsCjTY 0
904- 247 -SF345 p.1
_L ING PERMIT APPLICATION
Cr'TY OF ATLA_NTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
JOB' ADDRESS: _
PEANUT
YEW W OR REPLACEMENT INSTALLATION: Project Value $
Bathtub TYPE oa`a FIXTURE. C�
Clothes Washer Septic Tank & Pit
Dishwasher Shower
Drinking Fountain . Shower Pan
Floor Drain Slop Sink
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sires Uth3al
Laua>tdry Tray Vacuum Breakers
Lavafo Water Connected Appliances
etherlxtures Water Heater
Water Treafing System
E -PEPE
TYPE OF Q .
;3atbtub TY'r� f3i»L -E 07-7
Clothes Washer Septic Tank & Pit
Dishwasher Shower
Drinking Fountain Shower Pan
Floor Drain -- Slap Sink
Floor Sink Three Compartment Sink
Toilet
Hose Bibs
Urinal
Kitchen Sires
Laundry Tray Vacuum Breakers
Lavatory Water Connected Appliances
O Fixtures Water Beater
Water Treating System
P.) /% SCELLANEOCS:
ewer Replacement ❑ Book Flow Prevent ❑
Grease Interceptor (Trap) a aIlor 3 seqtires 3 sets of pi<al
❑ Lawn S pr i n kl er System -uMber of
'1 Well Completion Fam_ Completed form to be submitted to the Building e
5 pa r+rierrt for final inspection .
s. r
Hrma b=otnes 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 �apitcation and'.rnow the � i
same to be true and correct. All provisions ()flaws and ordinances governing this -work will be complied with -whether specified
r nu_ The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of const7ti;c>ion.
x'-oi erty Owners Name 101 P11 L l *r.. or
Plumbing Company j>y st,°36�4 Inc. phone Number - J`
n �� Corporate Court Office ?hone /'" - 7.2 , . - 61 4 3 -- r �j L
C. Address:
J .i�'i'�.J J_): !',;Cis wi•iaua re l.o'U 1.7Ya - — ?,_ _y7'u :.7
dress.
City State
s;se Holder ,. L.lp
(Print): t1c;ern State
Certifioationaegist atioaa # e r-,-i ,_ :2_2-
:VVtr rz20i 47 of License Homer 4 � .
■
Sworn and subscribed before me this Z i d - 1 ma y ; ) ` 4 cfi
20 V Signature ofNotary Public / f /(
0 t -0. Ne Public State of FI�
Neal. R Major
� My Commission EE0325
14'0-i ao Expires 12/20/2014
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