Permit Plbg Repipe 63 Coral St 2012 A
tr 4r40
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SO CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
" " -" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number . . . . . 11- 00003059 Date 1/05/12
Property Address 63 CORAL ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
14 FIXTURES REPIPE
Owner Contractor
COLLINS, PEGGY DAVID GRAY PLUMBING INC.
6491 POWERS AVENUE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32217
(904) 724 -7211
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 153.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 7/03/12
Other Fees STATE PLBG DCA SURCHARGE 2.30
STATE PLBG DBPR SURCHARGE 2.30
Fee summary Charged Paid Credited Due
Permit Fee Total 153.00 153.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.60 4.60 .00 .00
Grand Total 157.60 157.60 .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 SystemsClTY 0 904 -247 -5845 p,1
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
//�� �
Ph (904) 247 -5826 Fax (90 8) 247 -5845
JOB ADDRESS: ( ) dUAL oars U -1 PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value $ (
TYPE OF FIXTURE QTY TYPE OF FIXTURE OTT
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 • • ,
E 4 T1 her 'Fixtures Water Treating System
-,..._-•;"- TYPE OF FIXTLxE' TY TYPE OF FEE 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 4- Water Heater - T —
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Presenter ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of per)
❑ Lawn Sprinkler System Number of Heads ❑ Well **
** SIRWD ell Completion Form. Completed foma to be submitted to the Building Department for final inspection.**
tror 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 pennit does not give authority violate the provisions of any other state or local law regulation construction or the performance of constructon.
Property Owners Name fa cc Y G u b 1-01
'k' Phone Number 5 4‘--q34 1
Plumbing Company @' Gray Qt° 691, Inc. Office Phone / '- 7�:� s✓ Fax j3 -.
44-(9{ ?giy►e.2i Aye
Co. Address: City _ 47`,( , ;/l/I/ C State rs-- Zip ,4 " 7 "I I
License Holder (Print): �,1 Vi'P f &,J194 State Certification/Registration # er O :42 iC
Notarized Signature of License Holder n L 1 )-6
ap .►" "� 4 Notary Public State of Florida `worn and subscribed before me this ;16' day of / 20 ) L
, M R Major �/A , ? i ik, c � M y C Commission EE032510 - ignature of Notary Public �(iJZL(.1' ` a
'koF,,,c Expires 12/20/2014
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