Permit Plbg Septic to Sewer 999 Camelia 2011 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 11-00002905 Date 11/17/11
Property Address . . . . . . 999 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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RIEBER CHRISTY FIRST COAST PLUMBING
999 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 . . 5/15/12
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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 4-
JoB ADDRESS: PERMrF#
NEW OR REPLACEMENT INSTALLATION: Project Value
TYPE OF FIXTURE QTY TYPE oF FIXTURE QTY
Bathtub i Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Vacuum Breakers
Kitchen Sink
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
MISCELLANEOUS:
• Sewer Replacement El Back Flow Preventer o Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
• Lawn Sprinkler System-Number of Heads— o Well inal inspection."
SJRWD Well Completion Form. Completed form to be submitted to the Building Department for r
Ei Other
Pennit becomes void if work does not commence within a six month period or work is su ed 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.
Phone Numbert-9 a
Property Owners Name
1651 Maypod F Da Office Phone c-94L-A�4 4W
Plumbing Company LFax��
Co. Address: 4 AtlantiC Beach, FL 32233 city State_Zip
License Holder(Print): St*qr-ertification/Registration#
-1
Notarized Signature of License o W�
afi
—CHR, nKd6 me I �__&y of 204�_
JUUEYOU;Z STY $,,wom and subsc his
My COMMISSION#D 873293
EXPIRES:July 21,2013 ture of Notary Publi C
.#igna U
V W Bonded Thru Notary Public Underwrit--