487 Selva Lakes Cir 2012 repipe CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001613 Date 10/31/12
Property Address . . . . . . 487 SELVA LAKES CIR
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
10 Fixtures
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Owner Contractor
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CHARLES, CYNTHIA TRUST STEEG PLUMBING
487 SELVA LAKES CIRCLE 1601 MAIN STREET
ATLANTIC BEACH FL 322334355 ATLANTIC BEACH FL 32233
(904) 249-5191
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Permit . . . . . . PLUMBING PERMIT
Additional desc . . REPLACE FIXTURES . 00
Permit Fee 125 . 00 Plan Check Fee .
Issue Date . . . Valuation 0
Expiration Date . . 4/29/13
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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 125 . 00 125 . 00 . 00
. 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 129 . 00 129 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBIN O PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach.FL 32233
Ph(904) 247-5826 Fax(904) 247-5845
JO13 ADDRESS: y� �� �` �ia/ct l� PERM T# h/pf
NEIN OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE 07T TYPE of FixxTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drava 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 FDCFURE Q7Y TYPE OFFL UVRE QTY
Bathtub Septic Tank&Pit
Clothes Washer �_ Shower
Dishwasher Shower Pan
FDrinking SlopSink
loor Drain Thre Compartment Sink
Floor Sink Toilet Z
Hose Bibs Urinal
Kitchen Sink Vacuum.Breakers
Laundry Tray Water Connected Appliances
Lavatory __3 Water Heater �—
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plat
u Lawn Sprinkler System-Number of Heads — El Well *
x* SJRWD Well Completion Form. Completed form be submitted itted to the Building Department for final inspection.
❑ 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 1 have t
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 spec>:5
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 constructiot
Property Owners Name Phone Number -;7`f 3� -
Plu-nbilZg Company 9�r Office Phone c-;7y`f��/q/ Fax
—7 Cis /�G State�Zip, W
Co. Address: 2L� A –ly, J�� ty – C
LFdense Holder(Print): y,J J S Certification/Registration
Sam- ,. F er
r'P� SHIRLU 42
L GRAHAM 'nth cS day o 2
Pl/CC)M ISSIGN i DD 957760 work subscribed bef'o
EXPTtES:February 14,2014
F.�rdec!?hruNetaryPublicUntlerv;riters gnature Qf NOtary P1I c