237 Pine St 2012 repipe ��!•=11�1;r
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
�Nr Ji31�r~'
Application Number . . . . . 12--,110001123 Date 8/28/12
Property Address . . . . . . 237 PINE ST
Application type description PL BIND ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
14 fixtures REPIPE
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Owner Contractor
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MEIGS J VALERIE JAMES JOLLY PLUMBING
237 PINE STREET 1108 NORTH 24TH ST.
ATLANTIC BEACH FL 322334013 JAX BEACH FL 32250
(904) 241-9603
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Additional
Permit PLUMBING desc . .
Permit Fee . . . . 153 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 2/24/13
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Other Fees . . . . . . . . . STA E PLBG DCA SURCHARGE 2 . 30
STA E PLBG DBPR SURCHARGE 2 . 30
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Fee summary Charged Paid Credited Due
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Permit Fee Total 153 . 00 153 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 60 4 . 60 . 00 . 00
Grand Total 157 . 60 157 . 60 . 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 Atlanticeach, FL 32233
P (904) 243-5821 Fax (904) 247-5845
JOB ADDRESS: 423 % PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub S ptic Tank& Pit
Clothes Washer S ower
Dishwasher S ower Pan
Drinking Fountain S op Sink
Floor Drain Tree Compartment Sink
Floor Sink T flet
Hose Bibs U final
Kitchen Sink V icuum Breakers
Laundry Tray ater Connected Appliances
Lavatory VNIater Heater
Other Fixtures ater Treating System
I
RE-PIPE:
TYPE OF FIXTURE QTY T PE OF F/XTURE QTY
Bathtub �_ S(ptic Tank& Pit
Clothes Washer S I ower
Dishwasher SfjoweT Pan
Drinking Fountain Sl p Sink
Floor Drain Tree Compartment Sink
Floor Sink T ilet _
Hose Bibs � U'inal `
Kitchen Sink V cuum Breakers I
Laundry Tray W ter Connected Appliances
Lavatory W iter Heater
Other Fixtures W iter Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Inte'ceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
** SJRWD Wel Completion Form. Completed form to be submitt ed to the Building Department for final inspection.**
❑ Other
Permit becomes void if Mrkdoes 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 o finances governing this work will be complied with whether specified
or not. The permit does not give author' to violate th provisions of any of r stWr,local law regulation construction or the performance of construction.
Property Owners Name C / Phone Number
Plumbing Company � Office Phone ZD Fax
Co. Address: _ City Stateq Zip �J
License Holder(Print): A State C rt' cation/Registration# U _
Notarized Signature of License Holder
Sworn and subscribedefo e thi day f 20
Signature of Notary Pu is