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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 - -------------------------------------- ------------------------------------ Application desc 14 fixtures REPIPE --------------------------------------- --------------------- Owner Contractor - ------------------------ ----------------------- MEIGS J VALERIE JAMES JOLLY PLUMBING 237 PINE STREET 1108 NORTH 24TH ST. ATLANTIC BEACH FL 322334013 JAX BEACH FL 32250 (904) 241-9603 --------------------------------------PERM- �T- Additional Permit PLUMBING desc . . Permit Fee . . . . 153 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 2/24/13 --------------------------------------- ------------------------------------ Other Fees . . . . . . . . . STA E PLBG DCA SURCHARGE 2 . 30 STA E PLBG DBPR SURCHARGE 2 . 30 --------------------------------------- ------------------------------------ Fee summary Charged Paid Credited Due ----------------- ---- 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