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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 ---------------------------------------------------------------------------- Application desc retile 2 baths/wdo in sunroom ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ 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 ---------------------------------------------------------------------------- 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 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00 STATE PLBG DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- 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 b1i ----------- '�S:February 14,2014 S nature of Notary Pu c EXPIR� U "nte� Bonded Thru Notary Public Underwriters