Permit Plbg 434 Skate 2011 4 �� CITY OF ATLANTIC BEACH
r 1 800 SEMINOLE ROAD
J WJji = Z ATLANTIC BEACH, FL 32233
e rili S 1 sk
INSPECTION PHONE LINE 247 -5814
'
Application Number . . . . . 11- 00002779 Date 10/17/11
Property Address 434 SKATE RD
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
10 fixtures
Owner Contractor
DAVID GRAY PLUMBING INC.
8850 CORPORATE SQUARE CT.
JACKSONVILLE FL 32216
(904) 744 -7255
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 125.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 4/14/12
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 125.00 125.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 129.00 129.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Mer 08 10 12:54p Information SysternsCITY 0 904 - 247 -5845 p.1
PLUMIBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247 -5845 /�
SS: 4 }� o-`�'e, art PERMIT # //' �vl
JOB ADDkZE �.5�
NEW OR REPLACEMENT INSTALLATION: Project Value $ 2 I/ 14 G
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub _ Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Dram Three Compartment Sink .
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray — Water Connected Appliances
Lavatory Water Heater
( PPEy 1 Fi xtures Water Treating System
_
•
TYPE OF FIXTURE QTY TYPE OF FIXTURE Q77
Bathtub r Septic Tank & Pit
Clothes Washer / Shower
Dishwasher Shower Pan
Drinking Fountain S Lop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet Z '
Hose Bibs ° Urinal
Kitchen Sink ! Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Z Water Heater 1
Other Fixtures Water Treating System
MISCELLANEOUS:
L Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of pilaus)
❑ Lawn Sprinkler - System Number of Heads ❑ Well **
:S..rRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
C Other .. _..� _, ..
k' .r nit 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 rac
t` s 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 Mi. 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 b or i 5 Ai Phone Number l h Z "7 W Z-
luMbin , ink Office Phone 7 72-5
=' ''' Fax
f-iumbing Company David :,'� M --7_3-C.1)-62
8850 (: o rir see Square Court
Co. Address: , 2 n } 1 City State Zip
License Holder (Print): 449 ) 6;ei-it State Certification/Registration # er o1--1--'!
: ^,%lt. ,rated Signature of License Holder Avi 1 , / ,
Sworn and subscribed before me this I �� d . ( ' • 20 ti 1
L /�'
Signature of Notary Public .
of or a(' Notaryo.lie State of Florida
Neal ' u ajor
e ,:; '' M Commission EE032510
6 -.67,0,//
�orwo Expires 12/20/2014