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
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Application desc
1 fixture
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Owner Contractor
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ERICKSON, SARA J JERRY NOLAN PLUMBING INC
580 SHERRY DR 3115 HAMPSTED DR
ATLANTIC BEACH FL 322335354 JACKSONVILLE FL 32225
(904) 996-0051
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 62 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/07/13
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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 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