Permit Plbg 469 Atl Unit 5 2012 41 0 r J
.% 7 ° �,'� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
0 ` ' ri ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
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Application Number 12- 00000359 Date 3/29/12
Property Address 469 ATLANTIC BLVD UNIT 05
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
2 fixtures
Owner Contractor
DIAMOND REAL ESTATE PROPERTIES A TO Z CONTRACTING AND PLUMB
6517 LOU DRIVE SOUTH 406 HAMLET ROAD
JACKSONVILLE FL 32216 JACKSONVILLE FL 32221
(904) 378 -5071
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 69.00 Plan Check Fee .00
Issue Date . . Valuation . . 0
Expiration Date . 9/25/12
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 69.00 69.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 73.00 73.00 .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: C7 l fl-A-1 A.vi -,c— N U ik, ' ((S
PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE
Bathtub QTY
Clothes Washer Septic Tank & Pit
Dishwasher Shower
Drinking Fountain Shower Pan
Slop Sink
Floor Drain
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Laundry Tray Vacuum Breakers
Lavatory Water Connected Appliances
Other Fixtures Water Heater
Water Treating System
RE -PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE Q
Bathtub
Clothes Washer Septic Tank & Pit
Dishwasher Shower
Drinking Fountain Shower Pan
Floor Drain Slop Sink
Floor Sink Three Compartment Sink
Hose Bibs Toilet r
Kitchen Sink Urinal
Laundry Tray Vacuum Breakers
Lavatory
1 Water Connected Appliances
Other Fixtures Water Heater
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 fmal 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 6'1 i C L Q4 TA ti , o uS Phone Number S 13
Plumbin Company A -j2, ,,,Arrrc:,t d ,�,a \) b f Office Phone -.0 (WO) Fax � .), agd
:o. Address: 1 10,6 u PK 1�7�" Q
Cit 14 X State P ( Zip 34).1-J
License Holder (Print): N t \ y vvi
State Certification/Registration # CSC y ),
Votarized Signature of License Holder A ittillit A
H4 �
° •`•' Y f �S worthl, 4 Lai htibed 3efor- . - , _ . c of A /2
x.. , ■ ',�': MY COMMISSION DD 957760 20
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