Permit Plumbing Sewer 92 W 3rd St 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001734 Date 11/26/12
Property Address . . . . . . 92 W 3RD ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
Septic to Sewer
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Owner Contractor
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JORGENSEN CHRISTIAN E.J. CHRISTY FIRST COAST PLUMBING
92 W 3RD ST 1651 MAYPORT RD
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 247-4419
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Permit . . . . . . PLUMBING PERMIT
Additional desc . . SEPTIC TO SEWER HOOKUP
Permit Fee . . . . 62 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 5/25/13
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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 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: q,)- vc PERmrr#
CN�W R IMPLACENMNT INSTALLATION: ProJect Value$
TYPE oF Fmmm QTY TYPE oF Fmwiw QTY
Bathtub i Septic Tank&Pit
Clothes Washer Shower
Dishwasher ShowerPan
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-PIEPE:
TYPEoFFDcrum QTY TYPE oF FmmRE 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
AUSCELLANEOUS:
007ewer Replacement 0 Back Flow Pteventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
o Lawn Sprinkler System-Number of Heads— [I 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 stispended or abandoned fDr six months.I hereby certify tal I have read
this applicationand lmow the same tDbe 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 kate oF local law regulation construction or the performance of consauction.
Property Owners Name Phone Number.6-le(e- i-7��
Plumbing Company/7hrZ,--rb-j 1651 Maypod Road
. �w - — Office Phone a4l-44 q Fax.2?�—Ct D
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Co.Address: 9b Atlanbc Beach, FL 32233
hr city State_Zip
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License Holder(Print): !1 -1 State Cerwa�fton/Registration#
Notarized S4vrature of License koler
d 20
AMYOMCHRM Sworn an �®re day Of
MycommalOMD673293
EXPIRES-My 21,2013 Signature of Notary Public
BMW Thru Notary RAW WKIS�
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