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Permit Plbg Septic To Sewer 1335 Rose St 2012 .r. ��r�l , /1f `' �‘ 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 --, n 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, _ D EBOFlN�At .� ' t wo ,--, d subscribed before • - t 's '' b My ISSIpN # EE 051 4 pwe py underv�+riters I: d. of 21#��i • h . ture of Notar Public t/ -241,