Permit Plbg Repipe 869 Ocean Blvd 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000867 Date 7/10/12
Property Address . . . . . . 869 OCEAN BLVD
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
repipe
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Owner Contractor
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PATTERSON KIMBERLY B ET AL COURTESY PLUMBING INC
BOOTH ALLISON J & GEORGE A 11 1205 LAMANTO AVE
10442 BOSAHAN CT JACKSONVILLE FL 32211
CARMEL IN 46032 (904) 707-0862
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Permit . . . . . . PLUMBING PERMIT
Additional desc
Permit Fee . . . . 174 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date 1/06/13
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Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 61
STATE PLBG DBPR SURCHARGE 2 . 61
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 174 . 00 174 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 5 . 22 5 . 22 . 00 . 00
Grand Total 179 . 22 179 . 22 . 00 . 00
PERINI 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
0(1_e,4rV 3
JOB ADD� SS: IV d' PERMIT N
NE LACEMENT INSTALLATION: Project Value$
i 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
TIP Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
TYPE OF TURE QTY TYPE OF URE y
Bathtub Septic Tank I
Clothes Sher Shower
Dishw er Shower Pan
D Is ng Fountain Slop Sink
Ij
ri
F F]
h or Drain Three Compartment Sink
F oor Sink Toilet
se Bibs Urinal
Ki hen Sink Vacuum Breakers
1 Latin a Water Connected'opliances
Lavatory Water Heater
Other Fixtures Water Treating Syst�\
MISCELLANEOUS:
• Sewer Replacement E Back Flow Preventer ui Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
i
• Lawn Sprinkler System-Number of Heads Li Well
SJRWI) Well Completion Form. Completed form to be submitted to the Building Department for final inspection."
Li 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 applicati In and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified
9
or not. The*rrnit does not give auth it to violate the provisions of any other state or local law regulation construction or the performance of construction.
PIV 1XI
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Property Owners Name ��ere'"r\ Phone Number
Plumbing Company U Office Phone 90'1'707-0-6/02Fax
Co. Addr 'ss: ao��- LoryigA �--o f4L),e— city State/—L- Zip
License older(Print): WtA-7-. State Certification/Registration#0,19: t VgM4
Id
Notarized Signature of License Ho
SHIRLEY L G nd subscribed e e this ay o� _20—
MY COMMISSION#DDX7760
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at e of Notary PU 'c
LXPIRES:February ti;41gW
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Bonded Thru Notary Public UndervMters