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Permit Plbg Sewer Connection 1225 Hibiscus 2012 sl 4. N \ A CITY OF ATLANTIC BEACH ,-. 800 SEMINOLE ROAD 1 .7Z j:,,e ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number 12-00000405 Date 4/10/12 Property Address 1225 HIBISCUS ST Application type description PLUMBING ONLY Property Zoning TO BE UPDATED Application valuation . . . . 0 Application desc SEWER CONNECTION Owner Contractor OSBORN STEVEN F & MONICA DAVID GRAY PLUMBING INC. 1470 MARSH VIEW CT 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 . . 10/07/12 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 PERNII I IS APPROVED ONLY IN A( ( ORDAN( I ‘i I 111 Al I ( 111 01 11 [LAN I IC BE it II ORDINANCES AND I HE FLORIDA RI ILDING COW'S. Mar 08 10 12:54p Information SystornsCITY 0 9 04247-5845 p.1 PLUMBING PERMIT APPLICATION CITY OF ATLANTTC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247-5826 Fax (904) 247-5845 JOB ADDRESS: 2 C Air t .5 flekr PERA irr#_______________ NEW OR REPLACEMENT INSTALLATION: Project Value TYPE OF FIXTURE Qrr TYPE oF FrxruRE Was 217 Bathtub Septic Tank & Pit _______ Clothes her Shower Dishwasher Shower Pan ......___ Drinking Fountain Slop Sink Floor Drain __________ ......__ Three Compartment Sink Floor Sink ....______ Hose Bibs Urinal ........____ ___,...._ Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances ----- Lavatory _______ Water Heater _______ • 'Other 'Fixtures _L___. Water Treating System ___ RE-PIPE: TYPE OF FarvitE QTY Trim OF Frierms, 0 . Bathtub Septic Tank & Pit _____ Clothes Washer Shower Dishwasher Shower Pan ........---- Drinking Fountai n Slop Sink ....____ Floor Drain Three Compartment Sink Floor Sink Toilet ......____ Rose Bibs Urinal __ Kite' hen Sink Vacuum Ba rekers _______ Laundry Tray Water Connected Appliances _______ Lavatory Water Heater Wuter Tr....z..tin! Systzzl MISCELLANEOUS o Sewer Replacement 0 Back Flow Preventer 0 Grease Interceptor (Trap) gallons (Requires 3 sets of plans) Et Lawn .Sprimild er tystem-Number otHeads 0 Well ** ** SJRFPD Well Completion Form. Completed form to be submitted to tc-e'lknring Department for final inspection.** 0 Other , , ollI r ry' ______ Permit becomes void If work does not comm ence wi:hio a "..'c month period or work is suspended ar abandened fry: :ilt months. i aisr- certiiy that I have read this application and knew the same to be mike and curt All provisions of laws and ordinances goveestimt 6. 'ti wail he complimi with wheth pecLied or not The permit does mot give authority to violate Me prcmisions of any other state or local law r coastmmion or the performance of co Property OWIlen Name e 6,0 g a Phone Number je__Efril___ Devil 6ray Plumbing, ne. Office Mete . .L 5 Plumbing Co. Company —7----------'------/I—, ,.,.."' A.ddress: Lle i 044(14' a tie Cityjk61450gtircLE State .A Zip 1 ;4 License Holder (Print): 0 f State Cer tficazion/Registration # e.- i ' Notarized Signature 0 re of License Holder ......„„., , ...... , - OLT) 2 fo "' :, subsezibed Z ale i e / . . of ..,-■ fir,re 20 1 ____ ey Ni Notary Public State ot Ronda ! y -. Neal R Major 1' I m C Y otntrission EE032510 s ignatult of Notary Public M . 4, 'o o; P. Expwe 12/20/2014 ilf I i1 CITY OF ATLANTIC BEACH j. ) 800 SEMINOLE ROAD mo d` . c � ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number Property Address 12-00000378 Date 5/02/12 1225 Application type description SYSTEM DEVELOPMENT CHARGE RESIDENTIAL (S Property Zoning Application valuation . TO BE UPDATED 0 Owner Contractor OSBORN STEVEN F & MONICA 1470 MARSH VIEW CT OWNER ATLANTIC BEACH FL 32233 Permit ADV PMT -SEWER IMPACT FEE Additional desc . SDCH SEWER Permit Fee . . . .00 Plan Check Fee Issue Date . 4/04/12 00 Expiration Date . • Valuation 0 4/04/12 Other Fees SEWER SDC- SYSTEM DEV CHG 4050.00 Fee summary Charged Paid Credited Due Permit Fee Total .00 .00 Plan Check Total .00 .00 Other Fee Total .00 .00 .00 .00 4050.00 4050.00 .00 .00 Grand Total 4050.00 4050.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CHECK REQUEST DATE 03/27/12 ?P. 4 VENDOR NO 2948 7 PAYEE City of Atlantic Beach N4z1 : 1 -01,11.9* ,- ADDRESS 800 Seminole Road POSTED CITY Atlantic Beach STATE FL ZIP CODE 32233 ACCOUNT DESCRIPTION ACCOUNT NUMBER PROJECT NO. AMOUNT Sewer Other Contractual Services 410-5506-535.34-07 $4,050.00 Subtotal from Page 2 TOTAL $4,050.00 DESCRIPTION OF ITEM OR SERVICE: Sewer impact fee for 1225 Hibiscus St. RE No. 171058-0050 PA 1 D APR 0 4 2012 SPECIAL INSTRUCTIONS: CK Please forward check to the Building Department for processing To expedite processing, please attach adequate documentation to support payment. ADDITIONAL APPROVALS ONLY REQUIRED WHEN CHECKREQUESIISOVER701v/2 / e-0 REQU TED / DATE — DEPT HEAD / DATE FN NC 1 DIR / DATE MR DATE OAFinance\finance forms\Check & ACH Request Forms\[sewer impact fee check request.xlsjForm Pg. 1