Permit Plbg Septic To Sewer 1335 Rose St 2012 .r.
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`' �‘ CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
0"t,- "" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000927 Date 7/23/12
Property Address 1335 ROSE ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
NEW SEWER CONNECTION
Owner Contractor
BENNETT F REUBEN JR JOHN MOON PLUMBING
1335 ROSE ST 1103 PALM CIRCLE
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
Permit PLUMBING PERMIT
Additional desc . NEW SEWER CONNECTION
Permit Fee . . . 62.00 Plan Check Fee .00
Issue Date Valuation . . . . 0
Expiration Date . . 1/19/13
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 62.00 62.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 66.00 66.00 .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
33 Ph (904) 247 -5826 Fax (904) 247 -5845
JOB ADDRESS: J 3 ' g ` j
PERMIT # ` • 1
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE
Bathtub QTY
Clothes Washer Septic Tank & Pit
Shower
Dishwasher
Drinking Fountain Shower Pan
Floor Drain Slop Sink
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Laundry Tray Vacuum Breakers
Lavatory Water Connected Appliances
Other Fixtures Water Heater
Water Treating System
RE -PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE
Bathtub QTY
Clothes Washer Septic Tank & Pit
Dishwasher Shower
Drinking Fountain Shower Pan
Floor Drain Slop Sink
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Laundry Tray Vacuum Breakers
Lavatory Water Connected Appliances
Other Fixtures Water Heater
Water Treating System
MIS . ELLANEOUS:
`""' ^�4= 4;.:i ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) ( p) gallons (Requires 3 sets of plans)
❑ Lawn Sprinkler System- Number of Heads ❑ Well
** SJRWD Well Completion Form. Completed form to be submitted o the Bulding Department for final inspection.**
❑ Other C %�,, ��_ p
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 authty to violate the provision of any other state or local law regulation construction or the performance of construction.
Property Owners Name %,� ,�
Phone Number
Plumbing Company ...11Min Mr Office Phone 2 ,:72 76fax
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Co. Address: 410 ,� 4.A.
City �. State Zip "..3231
License Holder (Print): q ., "—
�., A. d1 State Certification/Registration # CfC D if
Notarized Signature o L' • , • -. _ 1111W ly AP,
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• h . ture of Notar Public t/ -241,