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Permit Plumbing 1983 Beach Ave 2012 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001444 Date 10/02/12 Property Address . . . . . . 1983 BEACH AVE Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 1 fixture ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ DATTILO THOMAS & JESSALYN JERRY NOLAN PLUMBING INC 1983 BEACH AVE 3115 HAMPSTED DR ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32225 (904) 996-0051 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 62 . 00 Plan Check Fee . 00 Issue Date . . . . valuation . . . . 0 Expiration Date . . 3/31/13 ---------------------------------------------------------------------------- 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. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904) 247-5826 Fax (904) 247-5845 JoB ADDRESS: 159-3 eccic'A 4vc PERMIT# NEW OR REPLACEMENT INSTALLATION: Project Value $ /10 7-5-- 0 TYPE OF FixTURE 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 RE-PIPE: TYPE OF FixTuRE QTY TYPE OF FixTURE QTY Bathtub Septic Tank& Pit Clothes Washer Shower Dishwasher ShowerPan 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: E Sewer Replacement E Back Flow Preventer F-1 Grease Interceptor (Trap) gallons(Requires 3 sets of plans) Li Lawn Sprinkler System-Number of Heads [i Well ** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection." i-_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 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 or local law regulation construction or the performance of construction. Property Owners Name -'-ff-1 10 Phone Number 'N S'70 Z) Plumbing Company J C!, -1 Office Phone Fax Co. Address: 3 5-0 L 1-1 city State License Holder(Print): V State Certification/Registration4 Notarized 5&nature o LLcem&, er Z S11IRL EY L.GPAHAM .2 C be4fore t4his 20 / — '0 0 J subscrib befor e this d of �,SION#DD 95776 orn ani �Jr4 it.,g Pu �.XV'�RPES:February 14,2014 Ronjp:4 I hru Notary Public.Underwriters gnature of Notary Pu