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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 ----------------------------------------------------- Application desc SEWER RECONNECT (OLD LINE COLLASPED) ---------------------------------------------------- Owner Contractor - ------------------------ ----------------------- LANE HELEN MURCHISON 3 YR TRUS TERRY VEREEN PLUMBING 3775 ORTEGA BLVD 2934 POST STREET JACKSONVILLE FL 32210 JACKSONVILLE FL 32205 (904) 384-5661 ------------------------------------------------- Permit PLUMBING PERMIT Additional desc . Permit Fee . . . . 62 . 00 Plan Check Fee 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 11/17/13 ------------------------------ 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) 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-