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1197 Mayport Rd Unit 1195 2012 PlumbCITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001661 Date 11/09/12 Property Address . . . . . . 1197 MAYPORT RD Tenant nbr, name . . . . . . UNIT1 Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 3 fixtures ---------------------------------------------------------------------------- Owner Contractor - ----------------------- SAFAR ANTON ------------------------ ROBERT "MIKE" SEEDERS PLUMBING 6949 LA LOMA DR 4525 CAPITAL CIRCLE N W 35 JACKSONVILLE FL 322172668 TALLAHASSEE FL 32303 (850) 562-2555 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 76.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 5/08/13 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2.00 STATE PLBG DBPR SURCHARGE 2.00 --------------------------------------------------------------------------- Fee summary Charged Paid Credited ------------------------------ Due ----------------- Permit Fee Total ---------- 76.00 76.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 80.00 80.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITI' 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: 1 __: /1 NEW OR REPLACEMENT INSTALLATION: RE -PIPE: TYPE OF FIXTURE Qry Bathtub Clothes Washer Dishwasher Drinking Fountain Floor Drain Floor Sink Hose Bibs Kitchen Sink Laundry Tray Lavatory Other Fixtures 4Nc.ttr S (n ks TYPE OF FIXTURE Bathtub Clothes Washer Dishwasher Drinking Fountain Floor Drain Floor Sink Hose Bibs Kitchen Sink Laundry Tray Lavatory Other Fixtures MISCELLANEOUS: ri Sewer Replacement Ifflo Project Value $ TYPE OF FIXTURE PERMIT ## /L —/w QTY Septic Tank & Pit Shower Shower Pan Slop Sink Three Compartment Sink Toilet Urinal Vacuum Breakers Water Connected Appliances Water Heater 1 nsf,�ne Oaf Water Treating System QTY TYPE OF FIXTURE QTY Septic Tank & Pit Shower Shower Pan Slop Sink Three Compartment Sink Toilet Urinal Vacuum Breakers Water Connected Appliances Water Heater Water Treating System E Back Flow Preventer j Grease Interceptor (Trap) gallons (Requires 3 sets of plans) [ 7 Lawn Sprinkler System -Number of Heads ❑ Well xx SIRJVD 3'ell Completion Form. Completed forrn to be submitted to the Building Department for final inspection.Y'� '� Other Permit becorr.es void if work does not commence within a six month period or work is suspended or abandoned for six months. 1 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 vrith whether specified or not. The permit docs not giveaui� rity to violate the provision of any other state or local law regulation construction or the performance of construction. Property Ownersl�i. ami Phone Number 7e 7" 973.Z Plumbing Companyp, �1�li�L�e � _� �_�Offce Phone 5�2-2 _, S FaxCSScS��-12Kd Co. Address: 4157" ?.15 Ccs g ke, f t r ty loll ftr cS e e State Fr zip.323C3 A License Holder (Print): State C4_t*ifieation/Registratton .Notarized Signature of License Holder Before me this 21-A day of M01i 204. t ; ..._ E LE N. W Signature of Notary- Public t lfyCOMMISSION* El:M11 atC b J�{rF��`0 $ended Thm Dido Wry SeP3 L•d 02ZLZ99099 6upwnldsiepeeg dL£:£OZLL0^oN 11/09/2012 08:02 8508917020 BLDG PERMITS PAGE 01/01 Robert "Mike" Seeders Plumbing, Inc 4525 Capital Circle NW J5 Tallahassee, FL 32303 (850) 562-2555 Name of R Qualifier: CONTRACTOR AUTHORIZATION FORM www.tnlgov.coni APPLICANT SERVICES (850)891.7125 FAX: $91.0948 RVILDINC INSPECTION (850) 891-7050 FAX: A91-7099 Location: 435 N Macomb St. Tallahassee, Florida 32301 Qualifier's License Number: AGENT(S) NAME (please print or type) 2. 3. 4. 5. 7. 8. 9. 10. The above named individuals are authorized to sign for permits and transact business for the company identified above. I understand that it is my sole responsibility as -thy qualifying contractor to keep thic .information current and resubmit a new accurate authorization form each time a change .needs to he made to the above list of individuals. / Z_ SIGNATURE OF QUALIFIER DATE STAT-gOF, y r COUNTY OF: a The foregoing instrument was acknowledged before me by -- r- {�� l' who is pens 61y!-07 to me or w o has produced as identification and who did not take an oath. WITNESS my hand and official seal this day of 6412 i / A.D., ZK3a_. DANIELLE N. NIX . ---•- c f MY COMMISSIQP! # EE 066581 015 Notary Public State of Florida at Large'* * EkedThlu agetNatch 11, irk �°r� of F,��` BondeQ 1"hru 6uagd NotaryServices l:building inspccdon/forms/2013 forms/contractor authorization form