Permit Plbg valves 555 Selva Lakes 2012 !,41
V Ai '21
� �� CITY OF ATLANTIC BEACH
0 800 SEMINOLE ROAD
Z
ATLANTIC BEACH, FL 32233
,1"139'"
INSPECTION PHONE LINE 247 -5814
Application Number . . . 12- 00000107 Date 1/26/12
Property Address 555 SELVA LAKES CIR
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
5 fixtures
Owner Contractor
CLAYTON THEODORE ET AL FOSTER PLUMBING, INC.
555 SEVLA LAKES CIR. 2905 HODGES BOULEVARD
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32224
(904) 821 -0707
Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 90.00 Plan Check Fee . . .00
Issue Date Valuation . . . . 0
Expiration Date . . 7/24/12
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 90.00 90.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 94.00 94.00 .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: 5 SE LV A C 1 P, PERMIT # ) Z'° 9 Z
NEW O " PLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub / W }7R V,cvv.a- 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 - ( 3 JJ c jx-rs --� 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 * *
** SIRWD 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 violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name Y-cO Phone Number
Plumbing Company f�-1" Office Phone 'E.1 Fax 8P--
Co. Address: Z9 QS x 4LO City --AD State -FL Zip S'2?7j
License Holder (Print): T;EP J , f0 -5 State Certification/Registration #C -Fc- 986
Notarized Sig _ -: - -- : . _ ,r .,LI , `-
d y r SHIRLEY L. GRAHAM .�—• ��- / �
.,_ !SAY COMMISSION # pktugc., d subs ��
`- ;K: EXPIRES: FebpJary 4 01Vg bed befo .I (1, of , 20 ' z
' �hQ . Bonded Thru Notary Public Underwrltors • , � •�
___. - of Notary Public