Permit Plbg Septic to Sewer 1441 Begonia 2012 t,3 s CITY OF ATLANTIC BEACH
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800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000014 Date 1/06/12
Property Address 1441 BEGONIA ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
septic to sewer
Owner Contractor
BURGESS PLUMB -PAL, INC.
1441 BEGONIA STREET 1728 SABLE PALM LANE
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 246 -8856
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 7/04/12
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
Ph (904) 247 -5826 Fax (904) 247 -5845
JOB ADDRESS: / y (7/ ?f` e ,n .", . c PERMIT #
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
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back 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 s bmitted to the Building Department for final inspection. **
III Other p7-,7 7?, -z /( / ¢1-,n,.,.q< ...7/ r,.� j /� e,' Sri- .Z_
P
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 /_ _ -- Phone Number
Plumbing Company ((u41 — f . ( - Office Phone e /.0 - 8 8SX Fax A .- c• , _,4
Co. Address: ! 7 ? ' 5:4 r -- t (.4., /.-,.. City _J-4x 2 c ( State 6? Zip 3 z Z5
License Holder (Print): v - :. State C '' • '. ' egistration # Cr( c e_5* 7L 7,-
Notarized Signature of License Holder --�,
24-Q.
/
a trn and ubscribed before 1 thi j day of ∎f - _i— 20/ --- DEBORAH AMANDA WHITE �� / i
, � M COMMISSION ^ ature of Notary Public / '
- : EXPIRES: May 21, 2015
t :' �� ' 1 Th Notary Public Undervmters
. 11j, ° eon