Permit Plbg Septic to Sewer 2011 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 11-0000287S Date 11/lo/11
Property Address . . . . . . 550 CAMELIA ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
SEPTIC TO SEWER
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Owner Contractor
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DAGLEY, DONALD CHRISTY FIRST COAST PLUMBING
550 CAMELIA STREET 1651 MAYPORT RD
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 247-4419
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 62 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 5/08/12
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Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
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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.
PLUMBING PEItMn APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845
JoB ADDREss: I% r PFJU%n#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FDrmAvE QTY TYPE oFFnrium QTY
Bathtub i ' Tank&Pit
Clothes Washer S
Dishwasher Sh%wcer
Drinking Fountain Shower Pan
Floor Drain Slop Sink
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Laundry Tmy Vacuum Breakers
Lavatory Water Connected Appliances
Other Fixtures Water Heater
Water Treating System
RE-P1[PE:
7)TE OF Fbrrum QTY TYPE OF Fbrrum
Bathtub Septic Tank&Pit QTY
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Laundry Tmy Vacuum Breakers
Lavatory Water Connected Appliances
Other Fixtms Water Heater
Water Tmatmg System
AUSCELLANEOUS:
11 Sewer Replacement ci Back Flow preventer Grease lntercePtor(Trap) gallons(Requires 3 sets of plans)
0 Lawn Sprinkler System-Number of Heads
7WD Well Completion Form- CompicteJ—form to 0 Well
0ther be subnUtt0d to the Building Department for final mspection.**
Permit bwAXnes void if work does not commence within a six month period or work is suspended"abandoned for six months.I her—eby certify
this application and know the same to be true and correct All provisions of laws and ordinances gov ing this that I have read
or not. The permit does not gi ern work will be complied with whether specified
live"Ority to viol the of any other Aft oF local law regulation construction or
Property Owners Name the performance of construquon.
Plumbing Company Al 16 Maypi:�ill Phone Number , � �)"i, —
Office Phone=;� Fax
Co.Address: hm. Aflanbc BeaCh, FL 32233—city State_Zip
License Holder(WPrint State Certifi #
Notarized Signature OfLicense catli 6 91
W H om
C R"TY on
M ION#DD 87=3
Yo�
RES.July 21,2013 ture
y"ic J, rwdte�
JUUE YOUNG CHRISTY and subscribed before this day of
'�y(30M
MWCO MISSIOWD87=3
EXPIRES:July 21,2013 S of Notary Public
Bonded Thruu Notary Public Underwriters