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Permit Well 427 Inland Way 2012 CITY OF ATLANTIC BEACH %* fJ 800 SEMINOLE ROAD = � ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00000672 Date 6/11/12 Property Address . . . . . . 427 INLAND WAY Application type description WELL PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ------------------------------------- Application desc new well --------------------------- Owner Contractor ---------------- ------------------------ TILLMAN STANLEY W AMERICAN WELL & IRRIGATION INC 427 INLAND WAY 49 ARDELLA RD ATLANTIC BEACH FL 322334682 ATLANTIC BEACH FL 32233 (904) 249-5400 - -------------------------------------- Permit . . . . . . WELL PERMIT Additional desc . . . 00 Permit Fee . . . . 75 . 00 Plan Check Fee Issue Date . . . . valuation . . . . 0 Expiration Date . . 12/08/12 ---------------------------------------- Special Notes and Comments Seperate permit required for electrical connection/wiring to new pumps A reduced backflow preventer must be installed if irrigation will be provided or if there is a private well on the property. Backflow preventer must be tested by a certified tester and a copy of the results sent to Public Utilities . --------------------- ------- Other Fees STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----- ---------- ---------- Permit Fee Total 75 . 00 75 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 79 . 00 79 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL, CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. • City of Atlantic Beach APPLICATION NUMBER Building Department I (To be assigned by the Building Depaftent) 800 Seminole Road1 ��✓/�! L _ Z-- Atlantic Beach, Florida 32233-5445"'?A" Phone(904)247-W26 • Fax(904)247-5 agcy �l Z E-mail: building-dept@coab.us Date routed: City wab-site: http.-/A~awb.ur. APPLICATION REVIEW AND TRACKING FORM Property Add r "l 2 bI Irry),I) W' Department review required Yes No Building Applicant: J f Planning&Zoning Tree Administrator Project: /V 1, Public Works Public tilitie Fire Sem2s_ Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept.of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other. APPLICATION STATUS Reviewing Department First Review: ]Approved. []Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by<`/ Date:4�+- TREE MIN. Second Review: ElApproved as revised. [-]Denied. P CSR Comments: UB ILI PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. [-]Denied. Comments: Reviewed.by: Date: Revised 07/27/10 PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH LMAY 800 Seminole RdAtlantic Beach, FL 32233 Ph(904)247-5826 Fax(904)247-5845 1 2012JOB ADDRESS: n � # NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE oFFIXTURE QTY TYPE oFFIXTURE Qom' 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 RE-PIPE: TYPE of FIXTURE QTY TYPE of FIXTURE QTY Bathtub Septic Tank&Pit Clothes Washer Shower Dishwasher Shower Pan g SlopSink F o1Fountain orDrainThe 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 Sprinkler System Number of Heads Well4— ** **SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final 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 ��'rn Phone Number !�)01 Plumbing CompanyAmtylUOffice Phone Fax L Co. Address: City �, State F.�,,.Zip —72 License Holder(Print): e 4 State rtificationlRegistration 7 Notarized Signature of License Holder Sworn d ubscribed be re a this. - a o 20Z Signa a of Notary Pu -c