763 Atlantic Blvd Unit c plumb TIC BEACH
KP CIT' OF ATLAN
800 SEMINOLE ROAD
'� s) ATLANTIC BEACH,FL 32233
I
� INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12- 0001093 Date 8/22/12
Property Address . . . . . . 763ATLANTICBLVD
Tenant nbr, name . . . . . . UNIT C
Application type description PL IBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
--------------------------------------- -----
Application desc
5 fixtures
--------------------------------------- ------
Owner Contractor
------------------------
------------------------
HANDLER FAMILY PARTNERSHIP DARLEYS PLUMBING INC.
65 S COLORADO BLVD 4472 PHILLIPS HIGHWAY
DENVER CO 80246104 JACKSONVILLE FL 32207
(904) 727-1484
-----Permit . .
. PLUMBING PERM T
Additional desc . .
Permit Fee 90 . 00 Plan Check Fee . 00
Issue Date . . . Valuation 0
Expiration Date . . 2/18/13
------------------------------------------------------
Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
-- ------ ---------- ----------
Permit Fee Total 90 . 00 90 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 94 . 00 94 . 00 . 00 . 00
I
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY 01 ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
it
PLUMBING PERMIT PPLICATION
CITY OF ATLANTI C BEACH
800 Seminole Rd Atlantic B'' ach, FL 32233 -
Ph(904) 247-5826 Fax(9 4) 247-5845 /
.TOB ADDRESS: AT' '�-'' � t7 e— vi"_ C PERMIT#
I
NEW OR REPLACEMENT INSTALLATION: Proje t Value $
TYPE OF FIXTURE QTY T PE OF FIXTURE QTY
Bathtub S ptic Tank&Pit
Clothes Washer S iower
Dishwasher S iower Pan
Drinking Fountain I S op Sink
Floor Drain Tree Compartment Sink
Floor Sink T ilet I
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray �— Water Connected Appliances
Lavatory Water Heater 1
Other Fixtures V later Treating System
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub S ptic Tank&Pit
Clothes Washer S hower
Dishwasher Shower Pan
Drinking Fountain Sop Sink
Floor Drain J hree Compartment Sink
Floor Sink I oilet
Hose Bibs rinal
Kitchen Sink acuum Breakers
Laundry Tray Water Connected Appliances
LavatoryVater Heater
Other Fixtures N Vater Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Int rceptor(Trap) gallons(Requires 3 sets of plans)
i
❑ Lawn Sprinkler System-Number of Heads F,i Well **
** SJRWD Well Completlon Form. Completed form to be submi ted to the Building Department for final inspection.**
I
i.-_1 Other
Permit becomes void if work does not commence within a six month period or work i suspended or abandoned for six months.t 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 authority to violate the provisions of any other state r local law regulation construction or the performance of construction.
s
Property Owners Name 144JA LAjt. F.o�`u i� �w N" I Phone Number(90y)3-?q–700
Plumbing Company r v Office Phone 717-I Yd y Fax-7 1OF
7
Co. Address: `/ //, City Us,.Uvh, I (c State F I ZipS U:, O7
License Holder(Print): Gn fir State Certification/Registration# C F G QSG 70.7
#"e Holder
comm*DMM192 • Sworn and subscribed before m this day of 20 ID
WWI� E)#rw a aM12
• Fbrde NotrAm.Ina • Signature of Notary Public
tiuq��n���uunnn�u�u
I
I __