119 Jasmine St 2013 plumbCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . .
13-00003061 Date
7/15/13
Property Address . . . . . .
119 JASMINE ST
Application type description
PLUMBING ONLY
Property Zoning . . . . . . .
TO BE UPDATED
Application valuation . . . .
0
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Application desc
INSTALL WATER HEATER
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Owner
Contractor
------------------------
PENDERGRASS, THOMAS W
------------------------
M & A PLUMBING INC
87 W 3RD ST
1186 PECAN COVE
ATLANTIC BEACH FL 32233
JACKSONVILLE FL
32221
(904) 477-5661
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Permit . . . . . . PLUMBING
PERMIT
Additional desc . .
Permit Fee . . . . 62.00 Plan Check Fee
.00
Issue Date . . . .
Valuation . . . .
0
Expiration Date . . 1/11/14
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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
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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
JOB ADDRESS: ��/ ,� �e S� 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
SlopSink
Floor Drain
Thre 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
Clothes Washer
Dishwasher
Drinking Fountain
Floor Drain
Floor Sink
Hose Bibs
Kitchen Sink
Laundry Tray
Lavatory
Other Fixtures
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer
Septic Tank & Pit
Shower
Shower Pan
Slop Sink
Three Compartment Sink
Toilet
Urinal
Vacuum Breakers
Water Connected Appliances
Water Heater
Water Treating System
❑ 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
Phone Number
Plumbing Company Office Phone y%z - % Fax
Co. Address:
License Holder (Print):
Notarized Signature of License Holder
City
State Zip
State Certification/Registration
Sworn and and subscribed before me this day of
Signature of Notary Public
20