Permit Plbg Septic to Sewer 1464 Camelia St 2011 J r J,
SZ , CITY OF ATLANTIC BEACH
''° I 800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
• X 01-3 1 >r
Application Number . . . . . 11- 00002977 Date 12/07/11
Property Address 1464 CAMELIA ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
CONNECT TO CITY SEWER AND ABANDON SEPTIC TANK
Owner Contractor
WEST, CHUCK JOHN MOON PLUMBING
1464 CAMELIA STREET 1103 PALM CIRCLE
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
Permit PLUMBING PERMIT
Additional desc . CONNECT TO CITY SEWER
Permit Fee . . . 62.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 6/04/12
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
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 11
Ph (904) 247 -5826 Fax (904) 247 -5845 1/4
PERMIT # �
/ �
JOB ADDRESS: : q � � /►���- ��
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
M ELLANEOU :
Sewer Re,...A ' '- lg. : ck Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Lawn Sprinkler System - Number of Heads ❑ Well * *
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection. **
❑ 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 olate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name _ Phone Number
Plumbing Company , f` r " .74i 0 )/ t Office �i
ne 2- --2./7'---d r�i
ax
Co. Address: ( ( 03 / C� �`�- City c''- 41_ State Zip 7
License Holder (Print):D • t'•-. - A _ State Certification/Registration # ��7Z‘
Notarized Si ?nature o License Holder , !e 1
_z �*� °+ DEBO RAH AMANDA WHITE . - f
i., . r4 ► and subscribed befor- / l day o / 20= r
j /
.: ` �M ; ir MY COMMISSION # EE 057349 /
c '' . EX May 21, 2015
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, , Bonded Thru Notary Public Underwriters • gnature of Notary Publi • w 1