339 11th St repipe 2012 (Jvl
4' `s 1 CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
1 s')
J;1, ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
4i4JJi )?
Application Number 12-00001808 Date 12/13/12
Property Address 339 11TH ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
repipe 9 fixtures
Owner Contractor
RENTZ HARRY G JR & NANCY M LARRY TEAGUE & SONS
339 11TH ST 203 OCEANFRONT
ATLANTIC BEACH FL 322335531 NEPTUNE BEACH FL 32266
(904) 270-2289
Permit PLUMBING PERMIT
Additional desc .
Permit Fee 118 . 00 Plan Check Fee . . . 00
Issue Date . . . Valuation . . . . 0
Expiration Date . 6/11/13
Other Fees STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
Fee summary Charged Paid Credited Due
Permit Fee Total 118 . 00 118 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 122 . 00 122 . 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 12 - 60
JOB ADDRESS: I ' 9 //
51/-
4 PERMIT#
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 a 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 ___1__ Vacuum Breakers �j -
Laundry Tray Water Connected Appliances
Lavatory x Water Heater / ',\J� i
Other Fixtures -- — Water Treating System J
MISCELLANEOUS:
3 Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
i Lawn Sprinkler System-Number of Heads ❑ Well **
°* SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
3 Other
'ermit 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
his 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
Pr not. The permit does not give au
F.,
ority to violate the pr sions of y other state or local law regulation construction or the performance of construction.
Owners Name ii, �E (19 Phone Number o 1 � ��U
numbing Company _/J ■, _ /.) i Ag d a/./..., •ffice Phone 3W5661 Fax ggg 8512Z.
�o. Address: c393 7 it - 1 City 90X State 1/ Zip 3-2:14S
.icense Holder(Print):f it°/ GEC? State Certification/Registration# —c�o�✓J`�94
notarized Signature of License Holder , , _ , o' --_
NOTARY PUBLIOSTATE OF FLORIDA --∎a., — , ^ _
"'N Jean H. Edward3S, orn and subscribe, before me this / 3 day of � 20 !-2
:Commission#DD821008
,,.,,. Expires: DEC.15,20 gnature of Notary Public • _ ,� �► la' 1'.
BONDED TABU ATLANTIC BONDING CO.,