Permit Plbg Water heater 1661 E park Ter 2012 03„,,,,.„
1 f CITY OF ATLANTIC BEACH
0 800 SEMINOLE ROAD
J ` ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
- r J,3 e.,,,
Application Number 12- 00000370 Date 4/02/12
Property Address 1661 E PARK TER
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
1 fixture
Owner Contractor
KETTERINGHAM, JOHN DAVID GRAY PLUMBING INC.
1661 PARK TERRACE EAST 6491 POWERS AVENUE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32217
(904) 724 -7211
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 9/29/12
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.
Mar 08 10 12:54p Information SystemsCfTY 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 -5845
JOB ADDRESS: floe? //4 R Atf l4r-r PERMIT
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE • Q77 TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Dram Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater 1
- Other Fixtures Water Treating System
RE -PIPE:
TYPE OF FI XTVRE QTY TYPE OF FIxruRE C
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain - Slop Sink
Floor Drain Three Comraraazent Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
FaLTIA Eater Tr° ,tines Svst.
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plaza)
❑ Lawn Sprinkler System Number of Heads ❑ Well **
** SIIZWD Well Completion Form. Completed form to be submitted to the Buiidin Department for final inspection. **
❑ Other._
Permit becomes void if work does not commence w :bin a sz : month period or work is suspended or abandoned m: ._, . =TALL s .y certify that 1 have read
this application and know the same to be true and =me"— Al! .arnvisions of laws and ordinances govrazing this Tint; will be complied with whether specified
or not The permit does not give auth. 'n to viciate the provisions of any other state or local law r_ t;dcu construction or the performance of con`truction.
Property Owners Name r 4' IVY I'��f�
g/A(( �r(,P j _ Phone Number I 2 9
Plumbing Company ! yid Gran Plumbing, Inc. nC
Office Phone 71e Fax 7;1-3- S644'
Co. Address: l0 PGit10 5' q' 1/0 _ City kdi4ogv[cc -L State Zip
z - - - --
License Roider (Print): Pirli O State Certification/Registration # C //' 1 ' - 44
Notarized Signature of License Holder -
Sworn attd subscribed bef me this - n ida - of 20 l
Signature of Notary Public ♦ hf ( u
oy,Rr °o ff Notary Public State of Florida
4, 1 1 Neal R Major
My Commission E1E 032510
Expires 1 212 0/2 0 1 4