820 14th Street West PLUMB 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001818 Date 12/14/12
Property Address . . . . . . 820 W 14TH ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
new sewer line
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Owner Contractor
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SIMMONS, DEBRA A CHRISTY FIRST COAST PLUMBING
820 W 14TH ST 1651 MAYPORT RD
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 247-4419
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 62 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 6/12/13
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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 4-
JOB ADDRESS: PERNff r 4 12 4/9
LNEW�R REPLACEMENT INSTALLATION: Project Value$
,TYPE oF Fbrrum QTY TYPE oF FmTuRE QTY
Bathtub i 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-PIEPE:1
TYPE oF FbauRE QTY 7)rPEoFFDrruRE QTY
Bathtub -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
MISCELLANEOUS:
Ei Sewer ROplacement 0 Back Flow Preventei 11 Grease Interceptor(FraP) gallons(Requim 3 sets of plans)
o LaWn Sprin1der System-Number of Heads 0 Well
**&IRWD:Well Completion Form. Completed form to be submitted to the Building Department for final inspection."
El Other ov-
Permit becomes void if wo&does not commence vathin a six month period or work is suspended or abandoned fDr six months.I hereby certify that I have read
this application and know the same to be true and correcL All provisions of laws and ordinances governing this work win be complied with whether specified
or not The permit does not give authority to A late the rovisions of any other state or-local law regulation construction or the poformance of construction.
Property Omers Name ....bbNe_ 7ynwn�'- Phone Number. �"yv
Plu.mbing Compyny -�Iry _ 1651 Maypod Road
� a� , L -Of fice Phone Fax
Co.Addres,o: /Ir. Atanbc Beach, FL 32233 city State_Zip
License St*eCezPtiafton/Regtstratton#e7Q
1141der(Pt in Qh
Notar&,ed qignature of License"oer'_*
Z' JULJEYMW0fM Swom anA su�qr �54enl day of ITZaahtC 20
MY COMMMION#DD 873293
...... EXPIRES:July 21,2013 Signature of Notary Public
Baxletl Thru Notary Pubic Lhkwlters
11 07