Permit Plumbing 553 David St 2012 .11
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
I it
Application Number . . . . . 12-00001538 Date 10/19/12
Property Address . . . . . . 553 DAVID ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
REPIPE 8 FIXTURES
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Owner Contractor
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OLSON JAMES S ET AL PLUMB-PAL, INC.
NICODEMUS KALYN A R/S 1728 SABLE PALM LANE
164 WILLIAM G DR JAX BEACH FL 32250
TEWKSBURY MA 01876 (904) 246-8856
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Permit PLUMBING PERMIT
Additional desc REPIPE 8 FIXTURES
Permit Fee . . . . 111 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/17/13
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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 111 . 00 111 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 115 . 00 115 . 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:
P PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
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"eater
Other Fixtures Water Treating System
RE-PIPE:
TYPE OF FixTURE QTY TYPE OF FrxTURE 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:
o Sewer Replacement Ei Back Flow Preventer o Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
[_1 Lawn Sprinkler System-Number of Heads 11 Well
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final 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 construction.
Property Owners Name LA�J Nr 9 0 crlfwn U Phone Number
Plumbing Company f?A( T�'VS Office Phone 2>Z—(FRSQ� Fax
Co. Address: City State zip _?2
License Holder(Print): t24.1d,r 12g,_-�,i State CcAWcation/Registration 74
Notarized Signature of License Holder
Sworn and sub<c�ribed bef me Aay f 20 12-
Signature of Notary Public