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Permit Plumbing 580 Sherry Dr 2012 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001487 Date 10/09/12 Property Address . . . . . . 580 SHERRY DR Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 1 fixture ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ ERICKSON, SARA J JERRY NOLAN PLUMBING INC 580 SHERRY DR 3115 HAMPSTED DR ATLANTIC BEACH FL 322335354 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 . . 4/07/13 ---------------------------------------------------------------------------- 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 ALI, CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC 13EACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904)247-5826 Fax(904)247-5845 JOB ADDRESS: er r-7 PERmrr NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE oF FixTuRE QTY TYPE oF FLaum 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 Fmum QTY TYPE oF F)xTuRE 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: 0 Sewer Replacement 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans) 11 Lawn Sprinkler System-Number of Heads El Well **S:IRWD Well Completion Form. Completed form to be submitted to the Building Department for fmal inspection." ii 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 constrtiction. Property Owners Name Phone Number 0 k' -00 Plumbing Company 'IV- Office Phone '4 1/ Fax Co. Address: 3115 (4,z--,,o City 11c State F'&Zip 9 — License Holder (Print): J 1=7 c,7-,/V. /4 t- State Certification/Registration 7S';� Votarized Signature of License Ho'l(ider E: s c F) SHIRLEY L.GRAHM), yoland subscribed be, e ra this day 0 20/2— My CUAIM16SION D 014 ic 'ES:Febivary 14, 014 EXPIR '?i;;�W B ndc�d Thru Notart Public Un e of Notary Public