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Permit Plumbing 1941 Francis Ave 2013 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00001985 Date 1/11/13 Property Address . . . . . . 1941 FRANCIS AVE Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc water heater ---------------------------------------------------------------------------- Owner Contractor ------ ---- ----- - - ----- -------- --- - BOWMAN MARY HELEN A J MOREL PLUMBING INC 1941 FRANCIS AVE 8915 CASTLE ROCK DR ATLANTIC BEACH FL 322334315 JACKSONVILLE FL 32221 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 62 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 7/10/13 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00 STATE PLBG DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 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 1,qj_11 EzancL� Ave- ALZJzLLC_ 6ta6(-J) ___PERMrr# JOB ADDRESS: NEW OR REPLACEMENT INSTALLATION: ProjectValue$ IqO. 00 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 bF 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: �i Sewer Replacement o Back Flow Preventer Ei Grease Interceptor(Trap) gallons(Requires 3 sets of plans) i Lawn Sprinkler System-Number of Heads El Well SJRWD-Well Completion Form. Completed form to be submitted to the Building Department for final inspection." Other Pen-nit 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 mcu2v 8momar? Phone Number VIE -9,39-119q Fax qL�-�_) t Plumbing CompanyAl AAaaj P114 --,hlm M. Office Phone %1f jr Wjk Zip �_:?-?jJ1 Co. Address: gqkli Eal;�Ie P—OdDr, a)ville- city _StateR, License Hold er(Print): A Slate Certification/Registration 0—Ifel- 1 =J:�7 I LA, Notarized Signature of License Holder j V."'3 � - \'j Sworn and subscribed before me this ljom - dayof (Ja12a,?P&_2013 SUSAN P.CARULE Comrrission#DD 857483 Exores February 3,2013 Signature of Notary Public 8=WThTmyFainh=ww8W,1A5-7019 't 44y."'.1;- I