Permit Plumbing Fix 41 Coral St 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
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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
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Application desc
1 fixture
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Owner Contractor
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SHEPARD, HERSCHEL ROTO ROOTER SERVICES
41 CORAL STREET 2028 W 21ST ST
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32203
(904) 354-7321
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 62 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 3/24/13
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Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
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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
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