169 Poinsettia St Gas 2012 CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12- 0000792 Date 6/26/12
Property Address . . . . . . 169 POINSETTIA ST
Application type description MECEANICAL GAS PIPING
Property Zoning . . . . . . . TO EE UPDATED
Application valuation . . . . 0
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Application desc
3 OUTLETS
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Owner Contractor
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HANCOCK BANK EXPERT GAS APPLIANCE SERV CO
1022 23RD ST W P O BOX 338
PANAMA CITY FL 32405 CALLAHAN FL 32011
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Permit . . . . . . MECHANICAL GAS PIPE PERMIT
Additional desc . .
Permit Fee . . . . 65 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 12/23/12
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Other Fees . . . . . . . . . STATE MECH DCA SURCHARGE 2 . 00
STATE MECH DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 65 . 00 65 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 69 . 00 69 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OFATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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MECHANICAL PERMIT APPLICATION
CITY OF ATLANT C BEACH
800 Seminole Rd Atlantic Bc ach, FL 32233
Ph(904) 247-5826 Fax (9 04) 247-5845
.TOB ADDRESS: Q i PERMIT#
PROJECT VALUE $ 3 � ARI
REQUIRED
NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning: Unit Quantity Tons Per Unit
Heat: Unit Quantity BTU's Per Ur it Seer Rating
Duct Systems: Total CFM REQUIRED
REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning: Unit Quantity Tons Per Unit
Heat: Unit Quantity BTU's Per Ur it Seer Rating
Duct Systems: Total CFM REQUIRED
FIRE PREVENTION
Fire Sprinkler System Quantity (Requires 3 sets of plans)
Fire Standpipe Quantity (Requires 3 sets of plans)
Underground Fire Main Value (Requires 3 sets of plans)
Fire Hose Cabinets Quantity (Requires 3 sets of plans)
Commercial Hoods Quantity (Requires 3 sets of plans)
Fire Suppression Systems Quantity (Requires 3 sets of plans)
FIRE PLACES MISCELLANEOUS:
Prefabricated Fireplace Qty Autorr.obile Lifts
Gas Piping Outlets Boiler BTU's
Elevat rs/Escalators
ALL OTHER GAS PIPI Heat F xchanger
Quantity of Outlets Pump
#Vented Wall Furnaces Refrigerator Condenser BTU's
# Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
OTHER: C5 0 �c
Permit becomes void if work does not commence.within a six month period or work is si ispended 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 or inances 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 I ocal law regulation construction or the performance of construction.
Property Owners Name �' Phone Number_3/5--,5:3�5
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Mechanical Company fce Phonea
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Co. Address: / 19Z� 1.� City State f/&Zip,-3,-r7
License Holder(Print): State Certification/Registration# 7 E3
Notarized Signature of License Holder
Sworn and subscribed befo e this (dav)4 20
Signature of Notary Pu is