Permit Plbg Repipe 1746 Ocean Grove 2012 ; .= CITY OF ATLANTIC BEACH
7 . r ) 800 SEMINOLE ROAD
- N ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
' r - - i3 :
Application Number 12- 00000926 Date 7/23/12
Property Address 1746 OCEAN GROVE DR
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
12 fixtures re pipe
Owner Contractor
ACKRELL MICHAEL ROLLAND REASH PLUMBING .
475 MARINA BLVD 11501 W COLUMBIA PARK DR #208
SAN FRANCISCO CA 94123 JACKSONVILLE FL 32258
(904) 260 -7059
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 139.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 1/19/13
Other Fees STATE PLBG DCA SURCHARGE 2.09
STATE PLBG DBPR SURCHARGE 2.09
Fee summary Charged Paid Credited Due
Permit Fee Total 139.00 139.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.18 4.18 .00 .00
Grand Total 143.18 143.18 .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: /7--V6 Oe Z / 4:we_ �jf' i M, s 53 PERMIT #
NEW OR REPLACEMENT 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:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY h
Bathtub a 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
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (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. **
geoi. f El Other
Permit becomes void if w e s 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 sam o 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 auth�orityytt violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name /fit' ? X /PE-LL. ,,21-6
Phone Number
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Plumbing Company /ae-/ -/ t/A /� /€ 6, Office Phone7�O ^74 Fax 2 ' 07/6
Co. Address: //5O/ aii,„?ie 1 Afk A' % oP' ity X State L1 Zip ...?"25
License Holder (Print): nu +JO ?' A-Skl to Certification/Registration # r -0, 9 /7/
Notarized Signature of License Holder
i o Y Not ary Public State of Florida
o , worn and subscribed before me t • 0:23 day of �u t Y 20 Ca
Paul R Bagby
1� �A` MY Commission EE042408 . ignature of Notary Public . .,O.I�
or r‘o Expires 01/23/2015