Permit Plbg Repipe 507 Selva Lakes 2012 s4 ift,Av„ "� CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
0 r t j ATLANTIC BEACH, FL 32233
, " . xva
INSPECTION PHONE LINE 247 -5814
-OE
Application Number 12- 00000034 Date 1/11/12
Property Address 507 SELVA LAKES CIR
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
11 fixtures re pipe
Owner Contractor
CLAYTON, BOB E. LARRY TEAGUE & SONS
507 SELVA LAKES CIRCLE 203 OCEANFRONT
ATLANTIC BEACH FL 32233 NEPTUNE BEACH FL 32266
(904) 270 -2289
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 132.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 7/09/12
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.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) X47 -5845
JOB ADDRESS: 501 'SC.l Y Q ., La kjo CA rci ‘c, 3 2-2-3 3PERMIT #
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 1 Septic Tank & Pit
Clothes Washer 1 Shower — 1 Dishwasher — Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet __2
Hose Bibs Z... Urinal
Kitchen Sink 1 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 submitted to the Building Department for final inspection. **
❑ Other
1
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 goveming this work will be complied with whether specified
or not. The permit does not give au ority to violate the provisions of any other state or local law regulation construction or the performance of c
onstruction.
Property Owners Name Db L' t (• n Phone Number 6 1 0 4 - '241 '2`t " g Z
Plumbing Company I rr' 'A 1. =NM 11 it ' - 'hone 1 2 0 axgb T D — D[,lo/
Co. Address: � .� 1 City � j v State Zip 3
License Holder (Print): ' 1 fl u g m. A 1 ' f State C ification/Registration # IN ! 5
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: I:
Notarized Signature of License Holder 032)1 a T •
Sworn and subscribed before me 's / day of TkAiltatsy 20 l2,
x 0.4.00,4, Notary Public State of Florida
Lin E Maple Signature of No Public
y
y ( My Commission DDd50194 940,0 o Expires 01 /08/2013