Permit Plbg 150 Sherry Dr 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
W"hit ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000747 Date 6/13/12
Property Address . . . . . . 150 SHERRY DR
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
2 fixtures
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Owner Contractor
------------------------ ------ ----------------
COMMUNITY PRESBYTERIAN
F.W. FAIR PLUMBING CO.
CHURCH P.O. DRAWER 51558
150 SHERRY DR JAX BEACH FL 32250
' ATLANTIC BEACH FL 32233S236 (904) 241-7191
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Permit PLUMBING PERMIT
jAdditional desc . .
Permit Fee . . . . 69 . 00 Plan Check Fee . 00
' Issue Date . . . . Valuation . . . . 0
� Expiration Date - - 12/10/12
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Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
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; Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 69 . 00 69 . 00 . 00 . 00
I 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: PERMIT#
NEW ORR, EPLACEMENT 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
RE-PIPE:
i 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
kL.T ose Bibs Urinal
itchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCEL LANEOUS:
0 Sewer Re lacement El Back Flow Preventer Ei Grease Interceptor (Trap)
P _gallons(Requires 3 sets of plans)
El Lawn Sprinkler System-Number of Heads El Well
SJR WD 'Well Completion Form. Completed—form to be submitted to the Building Department for final inspection.
0 Other
— 1
Permit becomO void if work does not commence within a six month period or work is suspended or abandoned-for six months—1hereby certify-that I have read
this application Od know the same to be true and correct. All provisions of laws and ordinances governing this work will be co*mplied with whether specified
or not. The periinit does not give authority to violate the provisions of any other state or local @]a v regulatiop con�truction or the performance of construction.
Property Owners Name 040/4one Number
Plumbing Company
1A �X J�b
Office Phone J f(Tax 2� y,/ -Zva-T
Co. Address': city State Zip
License Holder (Print): ertification/Registration#
Notarized Signature of License Holder
SHIRLEY1
an subscribed beLofe m this
-A 20
--*S MY COMMISSI(5N M09571 f
EXPIRES:Feb
uAl
Bon*d'ed Thru Notary'p Notary Pu�iic
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