Permit Septic to Sewer 975 Camelia 2011 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 11-00002940 Date 11/29/11
Property Address . . . . . . 975 CAMELIA ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
CONNECT TO CITY SEWER/ABANDON SEPTIC TANK
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Owner Contractor
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BREEDING LOWELL & PRISCILLA DAVID GRAY PLUMBING INC.
C/O TED A WILDEROTTER 8850 CORPORATE SQUARE CT.
975 CAMELIA ST JACKSONVILLE FL 32216
ATLANTIC BEACH FL 32233 (904) 744-7255
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Permit . . . . . . PLUMBING PERMIT
Additional desc . . CONNECT TO CITY SEWER
Permit Fee . . . . 62 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 5/27/12
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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 ALI, CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Meir 08 10 12:54p infcf-matlion 8 yqtemsCFTY 0 904-247-6845 P.1
PLUMBING PER311T APPLICATION
CITY OF ATLANTic BEAC14
800 Semincle Rd AtIonfic Beach, FL 32233
Ph(904) 247-5826 Fax(904) 247-5845
J-,-)B ADDREss: PIRA=9 L/I
�;ETW, OR REPLACFM ENT E'4STALL-AT101N. Project Value s
TYPE oF Fi=N H Ty TIFTE OF i;�'IXTUR_- 0-1y
Bathtub Septic Tank&Pit.
Clothes Washe- Shower
�Dishwashier 'Shower P=
Drinking Fountain Slop Sink
Floor Drain Three Compartmeni Sink
Floor Sink Toilet
HoseBibs Urinal
Kitchen Sink Vacuum Break.-,-s
Laundry Tray Water Connected Appliances
LayztL�7_ Water Heater
-Other-Fixtures Water Ti-=dn-System
T
1Z
7"3TE o-F FEuzas OTY TYPEF OF RE 0-=
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher ShowerPan
Drinking Fountain Slop Sink
Floor Dinin Three Compartnent Sinl-
Floor Sink Toilct
Hose Bibs Urinal
Kitchen Sink Vacuum Break=
Laundry Tray Water Connected Appliances
Lavatory Water 11-1cater
Other Fixtx-es Water Treating Systern
po
. CELLANEOUS:
-X1,";.,vrer Replacement 11 Back Flow Pre-venter 0 Gr,�asc_Iaterc4:�ptor(Trap) gallons equires 3 sets of pinns,
71 a,7-n -w 1-Heads
V Sprinider System-Nu -ber cf ID Well
-- :3jRWD FlelfGompletion Fo". .. Completed fonnto be submittedto theBuilding Departrineat for fiani inspection._*
E Other
91-.119=__�1CX 4a
becomes void if work does not somn,encc wiihin a si-x month;-_riod or work is suspended or abandoned'or six months.I hereby czrt�;=,haye raa�
ft-i.-appEcarion and Rnow the sarne to be true and correct. All provL;ims of laws and ordinances governing this-Amrk will]be complied with whetber zp=if:,td
crnc�_ The permit does-tot&e 2uth oritl to ,rio late the pro-visions of any other=te or local law Tegulation construction or the performan=(If C0I3-_tr=,4C11.
P . r tY iAJAA�c-e)4k_r 'I/1)
rm)e Owners Name Phone Number -76k Y-
Fhiza',, Daw-1,111 G:-!,,vy Plumbing, Inc. 'I"-' F, —
iing Company Office Phcne 7 Z;-
8850 Square Court,
4",-C, Addicss: CiTy State Zip
'Y State Certificat: n/'11--egistration,4 eEr
Holder(Print): P .9 lay Le
rwrized SA�,n ature of Licel"Se H64-Ler Agmi ,n� /
V_ ir !A 0
Swom ami subscribe4d beforn rne this ;�> da3� 2C
Signatare of Notary Pubfic 7/p;)_�� �,J,L
ey PP, Notary Public State of Florida
K,
Neal R Major
My Commission EE032510
-_12*,d Expires 12/20/2014