Permit Plbg Septic to Sewer 1339 Rose 2012 i t � CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
- " s.. ATLANTIC BEACH, FL 32233
. INSPECTION PHONE LINE 247-5814
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12- 00000127 Date 1/31/12
Application Number
Property Address 1339 ROSE ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . • 0
Application desc
SEPTIC TO SEWER CONNECTION
Owner Contractor
FRANZONI MARK JOHN MOON PLUMBING
13 OAKWOOD ROAD 1103 PALM CIRCLE
JAX BEACH FL 32250 JAX BEACH FL 32250
Permit PLUMBING PERMIT
Additional desc . SEPTIC TO SEWER .00
Permit Fee . . . 62.00 Plan Check Fee .
Issue Date . . . Valuation . . . . 0
Expiration Date . 7/29/12
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 /� 12.7 Ph (914) 247 -5826 Fax (904) 247 -5845
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JOB ADDRESS: 7 A .! PERNH'T #
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NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE QT Y
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Dram Three Compartment Sink
Floor Sink To ilet
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:
6 -£ever 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. **
5 ther c eMt \ ( s
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 authorii viola the prod:' •ns of any other state or local law regulation construction or the performance of construction.
Property Owners Name L� z 4 Phone Number
Plumbing Company . s ///" trOr\/ Office P e r _ .4 FFax
'' ~ r Stag {� L Zip 3 Z Z �
Co. Address: , 3 / ' k City 1... � •
License Holder (Print): _ 1 s G\-) .�!/r 4 I ► ° , -- +tate Certification/Registration
Notarized Si_. - - ; al/% ��/ TI C• •
=' " ° . b -. _. . der 2
i d X R Y 2E s � s ubscribed be r '_thi s da of 0
4 t r E7 May 21, 2015
'i� - ��ded7h_N 4 e of Notary Publi• ::d` AL,4,/` __ .