387 4th St (unit 389) 2012 shower pan 6
CIT OF ATLANTIC BEACH
R J, 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
0A
Application Number
12-()0000972 Date 7/27/12
Property Address . . . . . . 387 4TH ST
Tenant nbr, name . . . . . . UNIT 389
Application type description PLU14BING ONLY
Property Zoning . . . . . . . TO E UPDATED
Application valuation . . . . 0
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Application desc
shower pan
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Owner Contractor
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IVERSEN IVER HANS & CHUNGJI ROLLAND REASH PLUMBING .
387-389 4TH ST 11501 W COLUMBIA PARK DR #208
ATLANTIC BEACH FL 32233 (AJACKSONVILLE
K O VIL E FL 32258
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Permit . . . . . . PLUMBING PERMIT
Additional desc . Plan Check Fee . 00
Permit Fee 62 . 00 .
Issue Date . . . Valuation 0
Expiration Date . . 1/23/13
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Other
---------------- ------------
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
.` r 800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (90#) 247-5845
.TOB ADDRESS: _T S PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE of FIXTURE QTY TYPE of FIXTURE QTY
Bathtub Sef tic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain S1 Sink
Floor Drain Thi ee Compartment Sink
Floor Sink To let
Hose Bibs Uri nal
Kitchen Sink Va uum Breakers
Laundry Tray WE ter Connected Appliances
Lavatory WE ter Heater
Other Fixtures WE ter Treating System
RE-PIPE:
TYPE of FIXTURE QTY TYPE of FIXTURE QTY
Bathtub Sel tic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slc p Sink
Floor Drain Thee Compartment Sink
Floor Sink To let
Hose Bibs Ur' al
Kitchen Sink Va uum Breakers
Laundry Tray WE ter Connected Appliances
Lavatory WE ter Heater
Other Fixtures WE ter Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well
** SJR WD 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 orc inances 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 cal law regulation construction or the performance of construction.
Property Owners Name ���P D �/ Phone Number
Plumbing Company 5, Office Phone��0 70 Faxo��0—Oq/6
Co. Address: /S/ O City State/C, Zip s--nZ-rV
License Holder(Print): j�CJL-A&A hAS14 St e Ce ification/Registration# QC"66_7117W
Notarized Signature of License Holder
Pw� Notary Public State of Florida worn and subscribed before e this 3L rIt"day of ) VL'e 2011-
?c, Paul R Bagby
<,�d' Exp1res 01ll23/20150a2aoa ignature of Notary Public