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Permit Plumbing Fix 41 Coral St 2012 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ri ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001387 Date 9/25/12 Property Address . . . . . . 41 CORAL ST Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 1 fixture ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ SHEPARD, HERSCHEL ROTO ROOTER SERVICES 41 CORAL STREET 2028 W 21ST ST ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32203 (904) 354-7321 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 62 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 3/24/13 ---------------------------------------------------------------------------- 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. PLUM13ING PERMIT APPLICATION Q)r" 4 C)Cr CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, Fl, 32233 Ph(904) 247-5826 Fax (904) 247-5845 JOB ADDRESS: C,(Sr0,\ PERMIT# NEW OR REPLACEMENT INSTALLATION: Project Value $ Otn-,C,.00 TYPE OF FixTuRE OTY TYPE or, FixTuRE QTY Bathtub Septic Tank&Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater Other Fixtures Water Treating System RE-PIPE: TYPE OF FrxTuRE QTY TYPE OF FixTuRE QTY Bathtub Septic Tank&Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater Other Fixtures Water Treating System MISCELLANEOUS: -i Sewer Replacement 1:1 Back Flow Preventer o Grease Interceptor (Trap) gallons (Requires 3 sets of plans) �i Lawn Sprinkler System-Number of Heads El Well SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection." :1 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 -his 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 )r not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. Property Owniers Name Phone Number 404 tv AV&ry )A ex V�t% r -7TIW-- Plumbing Company Office Phone ISVt-!1=L Fax!T;LA-qSS� Co. Address: City��C_)KSOW MZ#,Ute IL zip License Holder (Frint): State Ceitificatioi-VRegistration Cj;t 0%44 1' Nlotarized Signature of License Holder BAFSAM A.ADAM worn and subscribed before me this —TEA. day of 201% MY COMMISSION#EE 179625 EXPIRES:April 22,2016 ignature of Notary Public 8ondWThm%WryPUbkUndVmfteM I "" ii I