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Permit Plbg Septic to Sewer 1270 Hibiscus 2011 r i ��r s CITY OF ATLANTIC BEACH r. ra 800 SEMINOLE ROAD = ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 oa,, Application Number 11- 00002727 Date 10/04/11 Property Address 1270 HIBISCUS ST Application type description PLUMBING ONLY Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc septic to sewer Owner Contractor MILNER, WALTER COASTAL UTILITY CONTRACTORS 1270 HIBISCUS STREET OF JACKSONVILLE ATLANTIC BEACH FL 32233 P 0 BOX 6517 JACKSONVILLE FL 32236 Permit PLUMBING PERMIT Additional desc . Permit Fee . . . 62.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 4/01/12 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 SCANNED 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 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 JOB ADDRESS: ‘2 7O N t 616 u S 1 PERMIT # NEW OR REPLACEMENT INSTALLATION: Project Value $ 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 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 M CELLANEOUS: Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor nterceptor (Trap) gallons (Requires 3 sets of plans) ❑ Lawn Sprinkler System - Number of Heads ❑ Well ** ** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for 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 W A t-Te'2 VA)usi 02_ Phone Number (23C 767 m Plumbing Company l .p),:61-,c L L) ILI 1 (°KAT C17:4 Office Phone 84 24) C( Fax 317-74z Co. Address: '75 Cc 101 l.604o U. t—Vb City 4X Stated- Zip3ZZ)U License Holder (Print): 'CAE V State Certification/Registration ''ye_ 14z (e057 Notarized Signature of License Holder 45 ��a.a" lalcsiEu.��► LEA Sworn d subscri before me this 3 u day of Oc4 Lo ,e 20 l ■ .. :,r M, COMMISSION # 4, 2012 16 Signature of Notary Public 1 . - , 1 �---_ ��., �;.•� EXPIRES: June 14, 2012 � 9ondo Thru Notary Public Undenmters i �� E RG C � — -