Permit Plbg Septic to Sewer 1115 Stocks St 2011 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 11-00002898 Date 11/16/11
Property Address . . . . . . 1115 STOCKS 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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NELSON, RICHARD PLUMB-PAL, INC.
1115 STOCKS STREET 1728 SABLE PALM LANE
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 246-8856
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 62 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 5/14/12
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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 PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: �o r k! 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
MJSCELLANEOUS:
9'Sewer Replacement o Back Flow Preventer o Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
El Lawn Sprinkler System-Number of Heads Ei Well
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection."
El Other I / /.C 4�4 �^j-,_,4-
:y
Permit becomes void if work does not commence within a six month period or �gIWndo d for six months.I hereby certify that I have read
this application and know the same to be true and correct. All provisi s 's work will be complied with whether specified
or not. The permit does not give authority to violate the provisions t OWPO nstruction or the performance of construction.
Property Owners Name 4�CL�np_j -C Phone Number
Plumbing Company Office Phone Fax /L///4
Co. Address: /7,?/,' city _J;�y . State 14,Zip _322-5&
License Holder(Print): State Certification/Registration# C(C-y_-c,5�-747S'_
Notarize U
MY MMISSION r:E!,�'; 20(//
EXPIRES:May 21.20
z's:Worn bed before this da
Bonded Thru Notary Pubhc;:1!!-,.i�,v,*: e�
and su�Zri )Vo-f
Signature of Notary Publi
0