Permit Plbg 900 #116 Plaza 2011 •
Mar 08 10 12:54p Information SystemsCITY 0 904247_8845 p.1
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Pb. (904) 247 -5525 Fax (904) 247 -5845
JOE' ADDRESS: 4 Piit If (0 PERMIT #
NEW OR RENA cEivaNT INSTALLATION: Project Valve y
TYPE OFFJXTURE QTY TYPE OF .1 Qry
Bathtub Septic Tank & Pit
Clothes Washer Shower -
Dishwasher .Shower Pa
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavator Water Heater
Other Fixtures Water Treating System
RE-PIPE;
PIPE OF Fa OTY TYPE OF Fixrui - 07='
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
.JSCELLANEOtJS:
o ;Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of pinn7t)
❑ Lawti Sprinkler System-usher of Heads ❑ Well * T
. 1RWD Well Completion Form_ Completed form to be submitted to the Building Department for tea? inspection.**
VOther. 12,44.,(401, c a3
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bevotnes void if work does not commence, within a six month p or work is suspended or abandoned for si months. I hereby certify that I have read
tlis sppllcation and know the same to be true and correct. All pr vi ncns of laws and ordinances governing this work will be complied with whether speci^ed
or ncr The permit does not give �� tb ority to viola a provisions of ary other state or local law regulation construction or the performance of construction.
og�erty Owners NamEy''�'` C4 i Phone Number 24(
04
E'il =robing Company rjaOrd \t, Plumbing, inc.
7 Office Phone 1 - %,r:5 -) Fax "7;; -- ; 4f
88�. 0 ; 't ,o G Square e Court
cc, Arlkiress: _ City State Zip
(' 3/J's� t �j9 Certification/Registration # v L
:License loo &der rant): �' State Certi
r' ,�t,�,� � 2� �>
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�t. n„- Zea1 ��Qa�atraare of License Holder
y /�
S rorn and subsc bed before me this / day of �L!!�'ti 20 1/
•
Signature of Notary Public �/D� AL,
xo Notary Public State of Florida
Neal R Major
c- My Commission EE032510
� '�oi r� _ Expires 12/20/2014
rie ii4/0,- \\,,
CITY OF ATLANTIC BEACH
- 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002776
Property Address Date 10/14/11
PLAZA
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation
Application desc
1 FIXTURE
Owner
Contractor
DAVID GRAY PLUMBING INC.
8850 CORPORATE SQUARE CT.
JACKSONVILLE FL 32216
(904) 744 -7255
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee
Issue Date .00
Expiration Date . Valuation 0
• 4/11/12
Other Fees STATE PLBG DCA SURCHARGE
STATE PLBG DBPR SURCHARGE 2.00
2.00
Fee summary Charged Paid
Credited Due
Permit Fee Total 62.00 62.00
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.
?
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
• c INSPECTION PHONE LINE 247 -5814
011 9
Application Number
Property Address . . . • • 11- 00002776
Application type 900 PLAZA 116 Date 10/14/11
Application ype description PLUMBING ONLY
Property Zoning TO BE
_____ valuation . . UPDATED
0
Application desc
1 FIXTURE
------------------------------
----------------- - - - - --
Owner ------------------------------------
--------- ---------- Contractor
DAVID GRAY PLUMBING INC.
8850 CORPORATE SQUARE CT.
JACKSONVILLE
--------- ------- (904) 744 -7255
- - - - --- FL 32216
Permit . . PLUMBING PERMIT --------------- - --
Additional desc . ____ - -----
Permit Fee
Issue Date 62.00 Plan Check Fee .
Expiration Date Valuation
.00
--------------- - - - - -- 4 /11/12 0
-------------------- - - - - --
--
----------------
Other Fees ___
STATE PLBG DCA SURCHARGE
SURCHARGE 2.00
STATE PLBG DBPR
------- ------- ___ 2.00
Fee summary Charged ____
----------------
_ ___ Paid Credited
Permit Fee Total ---- -- Due
62'00 62.00
.00 .00
Plan Check Total .00
. . .00
Other Fee Total
Grand Total 4.00 4.00 .00 .00
66.00 66.00 00
.00