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1671 Beach Ave 2013 repipe C,� r � CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD r� ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 ��J33 fir, Application Number . . . . . 13-00003410 Date 9/16/13 Property Address . . . . . . 1671 BEACH AVE Application type description PLUMBING ONLY Property Zoning . . . . . . . RES SF DISTRICT Application valuation . . . . 0 ------------------------------------ Application desc 18 fixtures ------ -- ------------------------------------------------------------------- Owner Contractor -------------------- ------------------------ GAY SHIRLEY W TRUST TERRY VEREEN PLUMBING 1671 BEACH AVE LE 2934 POST STREET ATLANTIC BEACH FL 322335840 JACKS(904)0 84L5661 FL 32205 ---------- ----------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc - • Plan Check Fee . 00 Permit Fee . . . . 181 . 00 0 Issue Date Valuation Expiration Date 3/15/14 ----- _ STATE PLBG DCA SURCHARGE 2 • 72 Other Fees STATE PLBG DBPR SURCHARGE 2 . 72 Fee summaryCharged Paid Credited Due ---------- ----- ---------- - . 00 Permit Fee Total 181 . 00 181 . 0000 00 00 Plan Check Total • 00 . 00 Other Fee Total 5 .44 5 .44 . 00 Grand Total 186 . 44 186 .44 . 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 BFACH 800 Seminole Rd Atlantic Beach,FL 32233 ph(904)247-5826 Fax(904)247-5845 YOB ADDRESS: ' a PER1%ffr# ,EW OR REPLACEMENT INSTALLATION: ]Project ' aloe$ TYPE OFFIXTU Q TYPE OF FIXTURE QTY Septic Tank&Pit Bathtub Shower Clothes Washer Dishwasher Shower Pan Drinking Fountain Slop Sink Three Compartment Sink Floor Drain Toilet Floor Sink Ural Hose Bibs Kitchen Sink Vacuum Breakers Tray Water Connected Appliances Lawn Lavatory Water Heater Other Fixtures Water Treating System RE-PIPE: TYPE OF FIXTURE QTY TYPE OFFWVRE QTY Bathtub Septic Tank&Pit �--- Clothes Washer Shower Dishwasher Shower Pan Drfi i gFountain Slop Sink Floor Dram Three Compartment Sink Floor Sink Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry TrayWater Connected Appliances T-— Lavatory _ — Water Heater Other ixtures Water Treating System WISCELLANFOUS: ons(Requires 3 sets of pians) :i Sewer Replacement ❑ Back Flow Preventer 0 Grease Interceptor(Trap) � 3 Lawn Sprinkler System Number of Heads L Well r*SJRWD WeII Completion Form.Completed orm to be submitted to the Building Department for final inspection "X 7 Other 'mint becomes void if work does not commence within a sac month period or work is suspended or abandoned for six months I hereby certify that I have read his application and know the same to be true and corrtct All Provisions of laws and ordinances governinglation wj nsnuction or the Ps work-w be e fornaaace whetherlied with eons�ill �an" -r not The permit does not give authority to violate the provisions of arty other state or local law reSa Phone Number 'roperty Owners Name 'lumbir�g Companq ear c r � \-`f Office Phone Fax City ; �, State Zip 3�1n "o. Address: License Holder(Print): �-<< e r�� to -fication/Registration# - — Votarized ftflaWre o Lace older 7'