74 (78) 4th St Plumb 2013 CITY OF ATLANTIC BEACH
s 800 SEMINOLE ROAD
J ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002471 Date 4/15/13
Property Address . . . . . . 74 W 4TH ST
Tenant nbr, name . . . . . . 78 W 4TH ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
7 fixtures
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Owner Contractor
-
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COX, RUSSELL AARON TDG PLUMBING
14003 TOMAKA RD 4426 LOYS DRIVE
JACKSONVILLE FL 32225 JACKSONVILLE FL 32246
(904) 545-7341
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Permit . . . . . . PLUMBING PERMIT
Additional desc . . . 00
Permit Fee . . . . 104 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 10/12/13
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Other Fees .
. STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
Fee summary Charged Paid Credited Due
----------------- ----------
---------- --
Permit Fee Total 104 . 00 104 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 108 . 00 108 . 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 ! 1
Ph(904)247-5826 Fax(904) 247-5845
-. I J
JOB ADDRESS: �' y 1 //TL�9�T 10C (JR C,L 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 Septic Tank&Pit
Clothes Washer _L_ Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three
rlet Compartment Sink �—
Floor Sink
Hose Bibs Urinal
Kitchen Sink \ Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures wSeN CR_ Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection."
❑ 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 ('V'4- Phone Number
Plumbing Company T �: P L^ �'�9 Office PhoneS"_IS-�1 41 Fax _y-1 18'J�
Co.Address: L
city�A� EL—Zip321'4S-
State
License Holder(Print):
---� State Certification/Registration#
Notarized der
�'rq6 mo o•. I
*_ MY COMMISSION#y 195776 in this da
EXPIRES:February�4
Bonded Thm Notary Public Un
Signature of Notary Publ