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Permit Plbg 425 Atlantic 2011 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 11-00002942 Date 11/28/11 Property Address . . . . . . 425 ATLANTIC BLVD Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc REPIPE 4 FIXTURES ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ SALT AIR MOTEL F.W. FAIR PLUMBING CO. 425 ATLANTIC BLVD. P.O. DRAWER 51558 ATLANTIC BEACH FL 32233 JAX BEACH FL 32250 (904) 24 1-7191 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . REPIPE 4 FIXTURES Permit Fee . . . . 83 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 5/26/12 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00 STATE PLBG DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 83 . 00 83 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 87 . 00 87 . 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) 217-�826 Fax (904) 247-5845 /2 JOB ADDRESS: #7uk�rli� Iz,,JD PERmrr# 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 avatory Water Heater her Fixtures Water Treating System -PIPE: TYPE oF FixTuRE QTY TYPE oF FixTuRE QTY Bathtub 12, 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: Ei Sewer Replacement El Back Flow Preventer L:i Grease Interceptor(Trap) gallons(Requires 3 sets of plans) Li Lawn Sprinkler System-Number of Heads o Well ** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection." o Other Permit 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 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. Property Owners Name rx er 4 Phone Number?y,(— Plumbing Company Office Phone 71�) F aZW_ Co. Address: City State Zip License Holder(Print): A('0 State Certification/Registrati oln Ty �01 DA 'V V.Z ;rrS Notarized Signature of License Holder Ffrm I 00nd0d 21, Sworn and su s d Signature of Notary Pu li