589 Clippership Ln repipe 2013 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J ATLANTIC BEACH FL 32233
INSPECTION PHONE LINE 247-5814
J;3 )r�
Application Number . . . . . 13-00003539 Date 10/17/13
Property Address . . . . . . 589 CLIPPERSHIP LN
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
repipe
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Owner Contractor
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MOORE, PHYLLIS PLUMB-PAL, INC.
589 CLIPPERSHIP LANE 1728 SABLE PALM LANE
ATLANTIC BEACH FL 32233 JACKSONVILLE BEACH FL 32250
(904) 246-8856
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 146 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/15/14
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Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 19
STATE PLBG DBPR SURCHARGE 2 . 19
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 146 . 00 146 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 38 4 . 38 . 00 . 00
Grand Total 150 . 38 150 . 38 . 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
.TOB ADDRESS: j � C C i ,�p� �, o ,,, 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 1 Shower
Dishwasher I Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet Z
Hose Bibs Z_ Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray Water Connected Appliances 1
Lavatory Z Water Heater I
Other Fixtures Water Treating System I
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well
YX 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 �,. .5 n-7 LC Phone Number
Plumbing Company 441 2� -E f r " Office Phone 2 Y L Fax (V
Co. Address: i9h nn City�T x 'c( State EL, Zip 322.5 v
License Holder(Print): .,� State Certification/Registration# CFCoS76?b_
Notarized Signature of License Holder
PEv L.GRAHAM S orn and subscribed bef met ' day o 20
+;OMMISSION#DD 957760
_?cPIRES:February 14,2014
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bonded ThruNotary PublicUndenvriteSl ature of Notary Pu