425 Atlantic Blvd 2013 Repipe CITY OF ATLANTIC BEACH
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J 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . 13-00002479 Date 4/16/13
Property Address . . . . . . 425 ATLANTIC BLVD
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
REPIPE 7 FIXTURE
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Owner Contractor
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MCGUIRE NANCY F.W. FAIR PLUMBING CO.
425 ATLANTIC BLVD P.O. DRAWER 51558
ATLANTIC BEACH FL 322334021 JACKSONVILLE BEACH FL 32250
(904) 241-7191
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Permit PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 104 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 10/13/13
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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 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
Seminole inole Rd Atlantic Beach, FL 32233
aPh(904)247-5826 Fax(904)247-5845.
Jos ADDRESS: ,1 '�G' PERMIT##
pD
NEW OR REPLACEMENT INSTALLATION: Project Value$ Z f
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Septic Tank&Pit
Bathtub
Shower
Clothes Washer
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Dram Three Compartment Sink
Toilet
Floor Sink Urinal
Hose Bibs Vacuum Breakers
Kitchen Sink Water Connected Appliances
Laundry Tray Water Heater
Lavatory Water Treating System
Other Fixtures
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Septic Tank&Pit
Bathtub
Shower
Clothes Washer /
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Toilet —�---
Floor Sink �_ Urinal
Hose Bibs �_ Vacuum Breakers
Kitchen Sink Water Connected Appliances
Laundry Tray �_ Water Heater —�—
Lavatory Water Treating System
Other Fixtures
MISCELLANEOUS: gallons(Requires 3 sets of plans)
❑ Sewer Replacement ❑ Back Flow Prevent er ❑ Grease Interceptor(Trap)
❑ Well
❑ Lawn Sprinkler System-Number of Heads
Xx SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection."
❑ Other
is
or
r six
s.I hereby certify that I have
Permit becomes void if work does not commence within a six month period laws oared ordinances governanng this work will be complied with whether specifiedd
this application and know the same to be true and correct. All provisions of
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 inst coon•
f Mt Phone NumbeiZ C 5�' V
Property Owners Name Z�j��I Z � Fax
Office Phone
Plumbing Company -� ,� J' State ZipL D
/dig T� — City
Co.Address: �'6 D 37,�Ca
License Holder(Print): �tZ� �R j� tate Certification/Registration#
Notarized Signature of License Holder 20�
Before me this a
Signature of Notary Publi