Permit Plumbing 1902 N Sherry Dr 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001531 Date 10/18/12
Property Address . . . . . . 1902 N SHERRY DR
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1350
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Application desc
CHANGE 3 FIXTURES, CHANGE TUB TO SHOWER 4 TOTAL
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Owner Contractor
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PETERS, DONALD E LANCE MAXWELL PLUMBING, INC.
1902 NORTH SHERRY DR 8604 OLD ORANGE PARK RD
ATLANTIC BEACH FL 322334520 904 4583020
TALLAHASSEE FL 32303
(850) 528-6257
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Permit . . . . . . PLUMBING PERMIT
Additional desc - . 4 FIXTURES
Permit Fee . . . . 83 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/16/13
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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 83 . 00 83 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 87 . 00 87 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALI, CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Lance Maxwell Plumber Fax;850-562-6220 Oct 18 2012 12;10pm P001/002
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CITY OF ATLANTic BEACH
800 Sen3duOle Rd Atlantic Be=b, FL 32233
Ph(904)247-5826 Fax(904)247-5845
JOB ADDRm:
'k ISQI;N—S]L��Np_ PERWr#
NEW OR REPLAC]EmxNT INSTALLATION: Project Value$
ITPEOFEUTURE Qzy TrpEoFftauRE QTY
Bathtub Septic Tank&Pit
'Clothes Washer Shower
Dishwasher Shower Pan
Drinhug Fountain
Slop sink
Floor Drain Three COmPartment Sink
Floor Sink Toilet
Hose Rft Urinal
Kitchen Sink vacuum Bmakers
Launchy Tray Water Connected Appliances
Lavatory Water Heater
Other FLUmes Water Treating System
RE-PrPE.-
TYPE OF FVrrURE QTY TYPE oF F=w QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher
D i ki Shower Pan
m ing Fountam Slop Sink
Floor.Drain Tbree Compartment sink
'Floor Sink Toilet
How Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
LaVADXY, Water Heater
Other Rcuires,
Water Tmating System
'MSCELLANEOUS:
.0 Sewer Replacement 0 B.ack Flow Preventer a Cjma,,.e IntemeptDr(Trap) WM 3 Uts
pnons(Req
Of Ph=)
O'L4wn Spfinkler S
SJR WD.� ystem-Number of Hea& 0 Well
Well Completion Form. C-OMPICted—forffL to be.submitted to tie-—ERding Department for fmal inspection.*
40 Other
void if work does ox commenoc wid1%a six moatb period or work is suspmkd
this applicatkn" or aWmdmW for six mojmhs_I hm-eby certify that I have md
aadkww;hes=et0b0twaa4=ea All p.,isimg I.,,,s and ordinsam govamingft wmk wul be wmplied wfthvfie�,prA&d
or not The pa=does not gm auelority to vlolatk,
.the Pmvisiow of my otba swe Or 10c81 law mPWOn cow�on or the pedommee of=strucdm
ProPertY Ownen Name
Phone Number
Plunbing Company-�addke e ft,-�M-k 10 10
Co.Address: SnOA 6 r�,�
city statA- zipzacm—
Licenm UWder(Print): /v10+)CtkYQ11�-
State �r
Mo4wized Stnaikre of.License HoMer — X-� . �atlon/Registration# COCCO 57 W
J
Swom and subscdW before me this day of 20-1,1.
Signatme of Notary Public ice I 110 1-1 A��L
KMTYMEMM
MY COMMM 0 W�4M