Permit Plbg Water Treatment 103 Fleet Landing 2012 CITY OF ATLANTIC BEACH
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800 SEMINOLE ROAD
1 ATLANTIC BEACH, FL 32233
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` °�� - INSPECTION PHONE LINE 247 -5814
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Application Number . . . . . 12- 00000606 Date 5/17/12
Property Address 103 FLEET LANDING BLVD
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
WATER SYSTEM
Owner Contractor
NAVAL CONTINUING CARE AFFORDABLE WATER /KINDER INC
RETIREMENT FOUNDATION, INC 3760 KORI ROAD
1 FLEET LANDING BLVD JACKSONVILLE FL 32257
ATLANTIC BEACH FL 322334599 (904) 262 -0197
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 11/13/12
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.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 -5845
JOB ADDRESS: I n 3 FLEET LAN DiN G bl Ud ') AI each 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
Other Fixtures Water Treating System 1
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
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Lawn Sprinkier System - Number of Heads ❑ Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection. **
O Other
remit 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 co
t � e clo-r 7 1' I�
Property Owners Name PA i `, N ortfl A d /i-1UlS Phone Number
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Plumbing Company A \lord allel e \pJ A-TE(Z Office Phone 2472 -019 ' F a x � y 260 - (2.92
Co. Address: 3960 k06 gCad City c SOfU1Ile StateFL Zip 32157
License Holder (Print): ;(fl Alai A , fi "' State Certification/Registration # - 3 2 -
• i , ' . t , • /, , • Holder 1 Y � :�
e Nota Public State of Florida ni 20
4
Dorothy M Devore Sworn and subscribed bef• - me this 1 ' 6 day of - y l
My Commission DD840269
4 of f ," Expires Expires 02/09/2013 Signature of Notary Pu �� lic 1 1 - '� �2 1