Permit Plumbing 5121 Polaris Ct 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001788 Date 12/12/12
Property Address . . . . . . 5121 POLARIS CT
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 8500
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Application desc
retile 2 baths/wdo in sunroom
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Owner Contractor
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NAVAL CONTINUING CARE NORTH RIVER BUILDING SOLUTIONS
RETIREMENT FOUNDATION, INC 6771 SHINDLER DR
1 FLEET LANDING BLVD JACKSONVILLE FL 32222
ATLANTIC BEACH FL 322334599 (904) 838-9179
--- Structure Information 000 000 RETILE 2 BATHS WDO REPAIR IN SUNROOM
Occupancy Type . . . . . . RESIDENTIAL
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Permit PLUMBING PERMIT
Additional desc . .
Sub Contractor . . ASHLEY PLUMBING CO INC
Permit Fee . . . . 83 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 6/10/13
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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
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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 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: f G-..' PERMIT 12
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 Heater
Other Fixtures Water Treating System
RE-PIPE:
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 Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
F-i Sewer Replacement [-i Back Flow Preventer o Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
u Lawn Sprinkler System-Number of Heads 0 Well
** SJR WD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.
[i 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 6""s Phone Number
Office Phone Fax
Plumbing Company
Co. Address: City State r-1 zip a?,
4�f 9�441 41
License Holder(Print): --- A e12 State Certification/Registration #CFC05-?'?c"(
Notarized Signature of License Holder
orn and subscribed befor is Z--day f 20
M
SHIRLEY L.GRAHAM
lo('OHMISSION#DD 957760
1 01
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'�S:February 14,2014 S nature of Notary Pu c
EXPIR�
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Bonded Thru Notary Public Underwriters