278 Seminole Rd 2013 repipe i f CITY OF ATLANTIC BEACH
r, s) 800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
' INSPECTION PHONE LINE 247-5814
/oil
Application Number . . . . 13-00003553 Date 10/21/13
Property Address . . . . . . 278 SEMINOLE RD
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
repipe 8 fixtures
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Owner Contractor
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MESERVE, ELIZABETH J PIPE-RIGHT PLUMBING SVC INC
278 SEMINOLE RD 1311 TROTTERS WALK WAY
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32223
(904) 329-9795
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee 111 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/19/14
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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 Paid Credited Due
----------------- ---------- ---------- ---------
Permit Fee Total 111 . 00 111 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 115 . 00 115 . 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 �3
800 Seminole Rd Atlantic Beach, FL 32233 1
Ph (904) 247-5826 Fax (90 247-5845 1
JOB ADDRESS: / PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ 41;
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
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well
xX 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 violatethe provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name 7 1
Phone Number
II I
Plumbing Company � – r, ffice Phone Fax �—
Co. Address: _CA2 l City State/�Z Zip_222
License Holder(Print): 1 s�J State Certification/Registration# I�OG ��S S^`�
Notarized Si na=Liceseer se of er GRAHAMN#DD 957760 orn and subscribed b ore m i y ofruary 14,2014Public Undenwite ature of Notar Pu