Permit Plbg 3 fixtures 320 1st St 2012 -S
w . °;�`, CITY OF ATLANTIC BEACH
1 800 SEMINOLE ROAD
v ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000215 Date 2/23/12
Property Address 320 1ST ST
Application type description PLUMBING ONLY
Property Zoning RES SF DISTRICT
Application valuation . . . 0
Application desc
3 fixtures /and sewer replacement
Owner Contractor
PEAKE LINDSEY CHANTAL CUSTOM PLUMBING AND TILE
320 1ST STREET 2742 SETTLEMENT DRIVE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32226
(904) 860 -8957
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 76.00 Plan Check Fee .00
Issue Date . Valuation . . . . 0
Expiration Date . . 8/21/12
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 76.00 76.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 80.00 80.00 .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: 3 2 1) / S PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value $ Zir
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 1
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 1 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
SCELLANEOUS:
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 /WS R'Qe- Phone Number
Plumbing Company dk S �° 1 ' - t �G u %r -4� ,/ Tilt ��� Fax 62 9 e • -3 3 3
f Office Phone ��o —F 4 s 1 Co. Address: - 37 5 1- . 2 5:6 /-e- 4.r - .,.,I / J CZ__ City -J
tY Stater= ( Zip 3 a Z Z 4
License Holder (Print): 7 1f0 ris � � . , /v -z7Sui
State Certification/Registration # C (=c tgaimf
Notarized Signature of License Hol
? "r}ice 3HIRLEYL.GRAHAM and subscribed bef•re �4 this 3 ay of 20 1
MY COMMISSION # DD 957760
;a � e j EXPIRES: February 14,33 na a of Notary Public -4" :. <y�;�' Bonded Ttri Notary Public Underwriters