Permit Plbg 119 Fleet Landing 2012 l' i N „� ' CITY OF ATLANTIC BEACH
5, j 800 SEMINOLE ROAD
071 = ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000330 Date 3/23/12
Property Address 119 FLEET LANDING BLVD
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
1 fixture
Owner Contractor
NAVAL CONTINUING CARE DAVID GRAY PLUMBING INC.
RETIREMENT FOUNDATION, INC 6491 POWERS AVENUE
1 FLEET LANDING BLVD JACKSONVILLE FL 32217
ATLANTIC BEACH FL 322334599 (904) 724 -7211
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 9/19/12
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.
Mar 08 10 12:54p Information SystemsClTY 0 904 -247 -5845 p,1
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 -5815
JOB ADDRESS: / f Eki 1 FIN 0 /N 4' !J,✓ 9 47//9 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 —
Fixtures Water Treating System
RE -PIPE: .
TYPE OF FIXTURE QTY TYPE OF FIXTURE t.
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 Fi fir z: 'Voter 'Trzti. �� S a ste7.Z
MISCELLANEOUS:
❑ Sewer Replacement D Back Flow Presenter ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Lawn Sp rinkler System Number of Heads ❑ Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection. **
❑ Other . _
Permit becomes void if work does not continence within a six month period or work is suspended or abandoned for six months. 1 imereby certify that I have read
this application and know the same to be true and :.otre:i. All provisions ()flaws and ordinances govmning ties work will be complied with whether specified
or not. The permit does not give authority to violate the pro of any other state or local law r �gsuation construction or the performance of construction.
Property Owners Name h ler / p/4 Phone Number 24 990
Plumbin Company ti Gray Plumbing, inc. Office Phone
!; p y `{'`..L3":-‹ Fax 1,-3 -,5 43
Co. Address: £ t '/ 6vitJO 4 lfrit CitynCKS State ... .
Cti p hiZ 1' __
License Holder (Print): jVIO f: ? S e Certi{c 'on/Registration # C,/r.' et.
Notarized Signature of License Holder anaL .,_:
ow P oi` Notary Public state of Florida OM a-.._ _i subscribed before me this 14/7 day of /Q ( 20 tZ
y � y Neal R Major
My Commission EE032510 S awtr C of Notary Public
� F0 rOe Expires 12/20/2014
Mar 08 10 12:64p Information SystemsCITY 0 904- 247 -5845 p.1
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 -58$5
Jon ADDRESS: / / E1r 1 R 171N q (3 /1 4 PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value $
• TYPE OF FIXTURE Q7Y TYPE OF _FIXTURE Q TY
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Slower Pan -
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sin
Floor Sink Toilet
Hose Bibs Uric
Kitchen Sink Vacuum Breakers
Laundry Tray - Water Connected Appliances
Lavatory Water Heater — V — .
'OtherFixtares Water T_reatng System
RE -PIPE:
TYPE OF FIXTURE Qrr TYPE OF FIXTURE 0'I °?'
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sick
Floor Drain Three Comparrent Sink
Floor Sink Toilet
Floe Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavato-r`,' _ - --- Water EIeater
r . ' •� : - W'_'tJe: :r , ^° � � System
MISCELLANEOUS :
c Sewer Replacement 0 back Flow Preventer 0 Grease Interceptor (Trap) gallons (Requires 3 sets of pima)
e Lawn Sprinkler t yster.Nunnber ofHeads 0 Well *-
** SJRWD Weil Completion Form. Completed foam to be submitted to the Building Department for final inspection. **
0 Other. - . - _ .
Permit becomes void if work does not cornmcracc w then a sa;c month period or work is suspended or abandoned Cr six taot:ths. I rerthy certify that I have rend
this application and know the same to be tau and etz . Ail provisions of laws and ordinances gov rant rs to;.:: -.:-7.-3.- vi.3] be complied with whether spec lied
or not. The permit does not give authority to violate the provisions of any other state or local law .7 : :3 ' :.. c a cons or the performance of coastucticn.
Property Owners "Name AC 4fe l Pi1 vIM _.._ .... Phone Number 2 4' ' f te.
Pitnnbing Company Office Gl•3 Fkin bing, Inc. Office Phone ' :� y -
��L J �/y �� - -, .� Fax 7,7-3-,5 �
Co. Address: (Yc q! �UitJ *V1! VIII a/4(Vtt4- State A. Zip 5,74i
License Holder (Print): RIO f X7: Y` 5' e C:erl c^•-"onfRegistration # G h . 3
4
ltiotariz.ed Signature of Lice . e Holder 1 9- : ,
_ '�� '� Notar Neal R Major
y Public Stele -f Florida am Vic. i su bscribed bore roe this 'If day o f - -��` a 20 iZ'
=.
M S , , a o N o t ary Pub,oc
�, y � Y C o mmiss io n EE•�251 - - --
�oi iti E xp i re s 17!20/2014
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