Permit 2021 Selva Madera Ct 12/2011 repipe CITY OF ATLANTIC BEACH
0 E
7,-7-� ATLANTIC BEACH, FL 32233
L INSPECTION PHONE LINE 247-5814
Application Number . . . . . 11-00003041 Date 12/27/11
Property Address . . . . . . 2021 SELVA MADERA CT
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
----------------------------------------------------------------------------
Application desc
repipe 11 fixtures
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
BUSHNELL, VICTOR DAVID GRAY PLUMBING INC.
2021 SELVA MADERA CT. 6491 POWERS AVENUE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32217
(904) 724-7211
----------------------------------------------------------------------------
Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 132 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 6/24/12
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 132 . 00 132 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 136 . 00 136 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Mar 08 10 12:54p information SystemsCFFY 0 904-247-6845 P.1
PLUMBING PFIRMT APPLICATION
CIETY OF ATLANnC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(901) 247-5826 Fax(904)247-5845
JOB ADDRESS: SEIVA Mt43P�4 PERMIT F,
NEW OR REPLAC7-MENT INSTALLATION: Project Value
TYPE oF Fj=RE QTY TyrE oFFmruRE ory
Bathtub Septic Tank&Pit
Clothes Washer Shower
-Dishwasher -Sho-wer Pan
Drinking Fountiin Slop Sink
Floor Drain Three Compartnent Sink
Floor Sink Toilet
Hose Bibs Urin4l
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavati�ry Water Heater
-Other'Fixtures Water Treafimg System
=RE-PIEPE;
TYPE oF Fvubw QFY TYPE oF FLavRE QTY
'Bathtub �2 Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountaim Stop Sink
Floor Urain Three Compartment Sink
Floor Sink Toilqn
Rose Bibs Urinal
Kitchen Sink Vaculain Break=
Lilmdry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures 'Water Treating System
NUSCELLANEOUS:
o Sewer Replacement 0 Bark Flew Preventer 0 Greasc,Interceptor(Trap) gallons(Requires 3 sets of pl=z)
El Lawn Sprin1der System-Nmnber of Beads C3 Well
ive 1 c6mpl t, F Completcdfo3711to b�- sub ittedto the Building Departuent for final inspection.**
&RWD I e 10,Y orm.
o Other
Permit becomes%,aid if work does i3ot comrncn=within a six month period orwork is suspended or abandoned for six montlis.I heireby certify that I have rend
this appLication and know the t b tru, d=rrect, All provisions of laws and ordinances govezrting this woi�c will be complied with whether speccifi,:d
or noL The pemiat does not giZZ O.;W tie"'clatc mthe pro-visions of any other state or local 3wv regulation construction or the performance ofconstruction,
FA�i 7 �2
Property Owners Name 44-DUWAJ Phone Number 0&0.�
Davkl] 'Gray Plumbing, Inc. -5�< Fax-7-,7 F-Sod
Phunbing Company -Offic Phone /*/� 7; r, -
Co. Address: --lVd city -J&giaff4 17
zip
License Holder(Print): StateC '-fication/Registration?V- 0�,�9'6
Notarized Signature of Lie-ense Holder
Swom and subscribed before rme this day of 20
"Ay 0(,,
Notary Public State of Florida
0, ' '*W:� =ignatuxe of Notary Public Xm J.rIi
N e
eal R Major
my _ , 510
n EEE032510
:0 My Commission
!tv.0. Expires 1212012014