1585 E Park Ter Plumb 2012 CIT OF ATLANTIC BEACH
800 SEMINOLE ROAD
s)
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
12-0 000798 Date 6/27/12
Application Number . 1585 E PARK TER
Property Address . • • • •
Application type description PL ING ONLY
Property Zoning . . . . . . . TO E UPDATED
Application valuation . 0
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Application desc
1 fixture
---------------------------
Contractor
Owner
_ _ _ _ ------------------------
CROFT ROBERT W & EILEEN P C.W. WOOD PLUMBING
1585 PARK TERRACE EAST 1328 ROMNEY STREET
JACKSONVILLE FL 32211
ATLANTIC BEACH FL 32233 (904) 744-6604
----------
-----Permit .
PLUMBING PERMIT
Additional desc . Plan Check Fee . 00
Permit Fee . . . . 62 . 00 0
Issue Date Valuation
Expiration Date 12/24/12 --------------------------------------
-----
STATE PLBG DCA SURCHARGE 2 . 00
Other Fees
STATE PLBG DBPR SURCHARGE 2 . 00
_____ _ ______ ---------
Fee summary Charged
Paid Credited ---_Due
-_-
_ _ ------- ----- -
----- ----------
- . 00
Permit Fee Total 62 . 00 62 . 00 00 . 00
Plan Check Total . 00 . 00
4 . 00 4 . 00 . 00 . 00
Other Fee Total
Grand Total 66 . 00 66 . 00 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY CF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
t _ -
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,. FL 32233
Ph(904) 247-5826 Fax (9 4) 247-5845
JOB ADDRESS: S'
s �Gr- 2G'r&6 e PERMIT##
NEW O REPLACEMENT I ALLATION: ProjectValue$
TYPE OF IXTURE QTY T rPE OF FIXTURE QTY
Bathtub S ptic Tank& Pit
Clothes Washer S �—
Dishwasher < ower
Drinking Fountain Sop ink
Floor Drain Tree Compartment Sink
Floor Sink T flet
Hose Bibs final
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory ater Heater
Other Fixtures later Treating System
RE-PIPE:
TYPE OF FIXTURE QTY YPE OF FIXTURE QTY
Bathtub eptic Tank&Pit
Clothes Washer hower
Dishwasher hower Pan
Drinking Fountain lop Sink
Floor Drain 1hree Compartment Sink
Floor Sink oilet
Hose Bibsrinal
Kitchen Sinkacuum Breakers
Laundry Tray 'Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease In erceptor (Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads
Well *
** 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 lWf5- _ Phone Number Z
Plumbing Company
C- C�(�CJ ��+�� Office Phone 7cicl'660� Fax 7-L13_117'30
Co. Address:
_ City
�X Stater Zip3 ZZ y
License Holder(Pric /
State Certificatio Registration#G�G0S70y7
Notarized Signature of License Holder
ed before ^ this day o .ran 20 Z_
•ey''•. SHIRLEY L. nUndewriters
Alg,
� Pub is
; EXPI Febru
.fi p ' Bonded Thtu Notary P
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