1721 Beach Ave 2013 Sewer CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
ATLANTIC BEACH FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002702 Date 5/21/13
Property Address . . . . . . 1721 BEACH AVE
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
SEWER RECONNECT (OLD LINE COLLASPED)
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Owner Contractor
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LANE HELEN MURCHISON 3 YR TRUS TERRY VEREEN PLUMBING
3775 ORTEGA BLVD 2934 POST STREET
JACKSONVILLE FL 32210 JACKSONVILLE FL 32205
(904) 384-5661
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Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . . 62 . 00 Plan Check Fee 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 11/17/13
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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
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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) 24 -5826 Fax (904) 247-5845
JOB ADDRESS: 1 2 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 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
MCELLANEOUS:
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.**
[or'Other
eriod or work is suspended or abandoned for six months.I hereby certify that I have read
Permit becomes void if work does not commence within a six month p
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 author' to violate the provisions of any other state or local law regulation construction or the performance of construction/
Property Owners Name Phone NumbP,=� _
ffice Phon��I �LFax g8' 8
Plumbing Company l
Co. Address: L y Statoz' —Zin
LJ
State Ication/Registration
License Holder (Print): .r D�S�97
Notarized Signature of License Holder
Before me this day o 0
Signature of Notary Pub
h2-