537 Vikings Ln (vault) y x CITY OF ATLANTIC BEACH
j s 800 SENIINOLE ROAD
} ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 06-00034018 Date 10/04/06
Property Address . . . . . . 537 VIKINGS LN
Application type description ROOF
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 6000
--------------------- -------------------------------------------------------
Application desc
REROOF
-------------------------------------------------- --------------------------
Owner Contractor
-
------------------------
------------------ -----
WARREN WHITES ROOFING COMPANY INC
537 VIKING LANE 14262 PLEASANT POINT LANE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32225
(904) 220-5546
----------------------------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 75 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 6000
Expiration Date . . 4/02/07
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 75 . 00 75 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 75 . 00 75 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
3 s, CITY OF ATLANTIC BEACH
RECEIVE
j PLAN REVIEW SHEET CITY OF ATLANTIC BE C
BUILDING �', TONIN � S.MaKski
Building Department Public Works&Pu clic UtilitigQ L. Higgins
800 Seminole Road 1200 Sandpiper LaneJ �6 S. Doerr
Atlantic Beach,Florida 32233 Atlantic Beach,Florida 32233 R. Carper
(904)247-5800 (904)247-5834 t D. Kaluzniak
(904)247-5845 Fax (904)247-5843 Fax BY: ' l Public Safety
PLAN REVIEW COMMENT/-S
Permit Application# Q (� 40
Property Address: �� -7 V1 41 S LA'n
Applicant: / is
Project: ;PE Poo /C
Th' permit application has been:
Approved as noted by the Department.
Final application approval 11616t come from the Building Department.
Reviewed and the following items need attention:
00
Please re-submit your application when these items have been completed.
Reviewed By: Date:
Date Contractor Notified:
E CE IV E Q
CITY OF ATLANTIC BEACH
��Itl CITY OF ATLANTIC BEACH
j BUILDING 7.0NINC;
ROOFING PERMIT APPLICATION
OCT 0 3 2006
Date: go . 3. 0 ('0
PLEASE SUBMIT(2)COMPLETE S TS OF PLANS WHU
I BY: -
JobAddress: 537 Vikin4s t-}ant-ic Bch, Fl.
Owner of Property. Pat Warren
Address: 101 Margaret St Neptune Bch, Fl. Telephone: 241 -5009
Contractor: White' s Roofing Co. Inc State License Number: CCC 058017
Contractor's Address: 14262 Pleasant Point Lane Jax. Fl. 32225
Telephone: 904-220-5546 Fax: 904-743-3677
Scope of Work:Remove existing shingle roof, install new 30 year
architectural shingles_ . _ -
Deck Slope: -reater than 2.12 Less than 2:12
Valuation of work: $6, 000 .00 A p P R O V E u c nr.H
OF pTLNN 114 "
Product Name(Example: Timberline): Weatherwood C1�gupDING OFFICE
Manufacturer(Example: GAF): 6
ASTM Designation(s): FL 183 . 10
Required Inspections: Sheathing and Final
Signature of Owner: /I AA Date: 10 -3- 06
AS TO OWNER:
Sworn to and subscribed before me this 3L day of 0Cj& -e.L ,20 O(o
State of Florida,County of Duval
Notary's Signature:
� r
DEBBIE J.RITTER
P� MY COMMISSION#DD498944 Personally known
uF�oa EXPIRES: Dec.12.2009 ❑ Produced identification
(407)398-0153 Radde Notary kwice.com Type of identification produced
Signature of Contractor. Date: I o -3 -D 6
AS TO CONTRACTOR:
Sworn to and subscribed before me this day of I0 C, ,20 n
State of Florida,County of Duval
Notary's Signature:
� r DEBBIEJ.RITTER ❑ Personally known
MY COMMISSION#DD498844 ❑ Produced identification
SOF float EXPIRES: Dec.12.2009 Type of identification produced
(407)3N-0153 Florida Notary Sarvice.com
800 Seminole Road •Atlantic Beach,Florida 32233-5445
Telephone: (904)247-5800 •Fax: (904)247-5845 •http://www.cLatlantic-beach.fl.us
Page 1 Revised 2/21/03
Address of property being improved: -7 ��' � '{� 26(2-r
General description of improvements:
Owner -,4t Loetl- z-c, -
AddressOwner's interest interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor r jgy1 cz�l t
�11 ` f1 322
Address /,Y 4 p 2
V) . i4 0L/ 77_ c� - �Y� Fax No. Guy 7r i7
`� Phone No. �
Surety(if any)
r ` Address Amount of bond $
/ Phone No. Fax No.
j/rte Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself, owner designates the following person to receive a copy of the Lienors Notice as provided'rfi --
Section 713.06 (2) (b), Florida Statutes. (Fill in at Owners option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is one (1)year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: S°. L/C-.-Date:
Before me this I`.t day of a t L 2 C C`(�- in the
Doc#2006344739,OR BK 13556 Page 2452, County of Duval, State of Florida, has personally appeared
r
Number Pages: 1
Filed&Recorded 10!03/2006 at 10:25 AM,
JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING$10.00 Notary Public at Large, State of Florida, County of Duval
My commission expires: /,2,
Personally Known or
Produced Identifica
� MY COMMISSION#D11498841
�Fo nOa� E\PI RES: Dec.l2.2009
(407)393-0153 Florida Notary Sgrvic"Orn
. r
,
` = ILE COPT
MIAMI-DADE COUNTY,FLORIDA
MM I�ADE METRO-DADE FLAGLER BUILDING
140 WEST FLAGLER STREET,SUITE 1603
BUILDING CODE COMPLIANCE OFFICE(BCCO) MIAMI,FLORIDA 33130-1563
PRODUCT CONTROL DIVISION (305)375-2901 FAX(305)375-2908
NOTICE OF ACCEPTANCE (NOA)
GAF Materials Corp.
1361 Alps Rd.
Wayne,NJ 07470
SCOPE:
This NOA is being issued under the applicable rules and regulations governing the use of construction materials.
The documentation submitted has been reviewed by the BCCO and accepted by the Building Code and Product
Review Committee to be used in Miami Dade County and other areas where allowed by the Authority Having
Jurisdiction(AHJ).
This NOA shall not be valid after the expiration date stated below. The BCCO (In Miami Dade County) and/or
the AHJ (in areas other than Miami Dade County) reserve the right to have this product or material tested for
quality assurance purposes. If this product or material fails to perform in the accepted manner, the manufacturer
will incur the expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such
product or material within their jurisdiction. BCCO reserves the right to revoke this acceptance, if it is
determined by BCCO that this product or material fails to meet the requirements of the applicable building code.
This product is approved as described herein,and has been designed to comply with the Florida Building Code,
including the High velocity Hurricane Zone.
DESCRIPTION:Timberline 30
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no
vely affecting the performance of this product.
change in the applicable building code negati
TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the
materials,use, and/or manufacture of the product or process.Misuse of this NOA as an endorsement of any
product,for sales,advertising or any other purposes shall automatically terminate this NOA.Failure to comply
with any section of this NOA shall be cause for termination and removal of NOA.
ADVERTISEMENT: The NOA number preceded by the words Miami-Dadeof the NOAFlorida, and displayed,then it shall
ed by
the expiration date may be displayed in advertising literature. If any portion
be done in its entirety.
INSPECTION:A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors
and shall be available for inspection at the job site at the request of the Building Official.
This NOA revises NOA#01-1203.07 and consists of pages 1 through 4.
The submitted documentation was reviewed by Frank Zuloaga,RRC
CITY OF ATLANTIC BEACH
BUILDING OFFICE
QCj 0 4 2� NOA No.:04-0305.03
Expiration Date:02/21/07
{ _ Approval Date:04/22/04
Page 1 of 4
i'
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
INSPECTION EMAIL REQUEST:
Building-dept&coab.us
Application Number . . . . . 07-00001590 Date 11/20/07
Property Address . . . . . . 537 VIKINGS LN
Application type description MECHANICAL ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
------------------- --- - - -------------- ---------
Application desc
1 cu lahu
----------- - ---- ---- --- ---------- ---- ---- - ----- - --- ---------------- --- ------
Owner Contractor
------- ---- ---- -------- - ------------------------
WARREN AIR ENGINEERS INC
537 VIKING LANE 10947 BEACH BLVD
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32246
(904) 641-2333
------------------------------------------
Permit . . . . . . MECHANICAL PERMIT
Additional desc . .
Permit Fee . . . . 71 . 00 Plan Check Fee . 00
Issue Date Valuation . . . . 0
Expiration Date . . 5/18/08
--------------------- ---
--------------------
Fee summary Charged Paid Credited Due
---------- ---------- ---------- ----------
Permit Fee Total 71 . 00 71 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 71 . 00 71 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
r "Y:�
CITY OF ATLANTIC BEACH
MECHANICAL PERMIT APPLICATION
JI3 O `O
Date:
Property Address: q f
Owner: /1013 �2T Gc.�,4/L2r�n/ Telephone
Contractor:-4M 54Igf Pe t-I S Telephone #: o E
Contractor Address: /D'?U 5B6fC1J &V,o Fax #:
In consideration of permit given for doing the work as described in the above statement,we hereby agree to perform said work in accordance
with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach ordinances and standards of
pod practice listed therein. I.I'
Type of Heating Fuel:
If other construction is being done on this building i I'
or site,list the building permit number:
Q'Electric
❑ Gas: LP Natural Central Utility I`
❑ Oil
❑ Other—Specify
MECHANICAL EQUIPMENT TO BE INSTALLED NATURE OF WORK
❑ Heat _Space Recessed ZCentral _Floor ❑ Residential
❑ Air Conditioning: _Room _--Central
❑ Duct System: Material Thickness ❑ Commercial .
Maximum capacity cf n it
❑ Refrigeration ❑ New Building i hh
❑ Cooling Tower:Capacity gPm
❑ Existing Building
❑ Fire Sprinklers:Number of Heads
❑ Elevator: Manlift Escalator (Number) ❑ Replacement of Existing System
❑ Gasoline Pumps (Number)
El
(Number) 0 New Installation
El LPG Containers (Number) (No system previously.installed) .
❑ Unfired Pressure Vessel ❑ Extension or Add-on to Existing System
❑ Boilers
❑ Gas Piping ❑ Other Specify.
❑ Other—Specify
j
LIST ALL E UIPMENT
AIR CONDITIONING,REFRIGERATION EQUIPMENT&CONDENSOR'c Approving
Number Units Description Model# Manufacturer Ton's Agency I1
' j
HEATING—FURNACES,BOILERS,FIREPLACES&AIR HANDLER'S `' i Approving I'
Number Units Description Model# Manufacturer .,,BTU's Agency
, t
TANKS Nominal Capacity Type Liquid Serial Approving 1�
How Many &Dimensions Contained Manufacturer No. Agency
,
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800 Seminole Road •Atlantic Beach,Florida 32233-5445
Phone:.(904)247-5800• Fax: (904)247-5845 • http://www.ci.atlantic-beach.fl.us
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----------- - APPROVED
CITY OF ATLANTIC BEACH
BUILDING OFFICE
DEPARTMENT OF BUILDING 4460
CITY OF ATLANTIC BEACH, FLORIDA PERMIT NO.
PERMIT TO BUILD
THIS PERMIT MUST BE POSTED ON JOB
Date SPptemh r 1q 8f)
E Valuation$ 1:8,554,64 Fee $ 132.88
This permit not valid until above fee has been paid to City Treasurer, and is
subject to revocation for violation of applicable provisions of law.
This is to certify that New Met Co.
has permission to build a cinij f mi ly dwelling according to Flans
submitted.
Classification Residential Zone
Owned by New iv3et i dens
Lot 26 ra
Block 1'
1 Seas
I .S/D
House No. 537 Vikings Lane
I
According� g to approved plans which are part of this permit
t
NOTICE—ALL CONCRETE FORMS
AND FOOTINGS MUST BE IN-
SPECTED BEFORE POURING.
PERMIT VOID SIR MONTHS
AFTER DATE OF ISSUE
♦--� ► O Building material, rubbish and debris
from this work moat not be placed in
public space, and must be cleared up
and hauled away by either contractor
or owner.
Building official.
�r�/�Tr
FOR OFFICE PERMIT DATE CONTRACTOR (JP,d1bMi�f
USE ONLY NUMBER
4 " !
f PLUMBING - •01(iLi:1.`
.a '
ELECTRICAL
i it
SEWER
WATER
t
t:
wt�
r Date........... .�.............19 sU
CITY OF ATLANTIC BEACH Permit .....yes
:.�3 .. .
Valuation #--:i�gf.,.5:.��..lP....��.�.............
FLORIDA $vasa # ?....c� ..�N
APPLICATION FOR BUILDING PERM"
Application Is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the
building or other structure described. This application is made in compliance and conformity with the Building Ordinance of
the City of Atlantic Beach, Florida, and all provisions of the Laws of the State of Florida, all ordinances of the City of Atlantic
Beach and all rules and regulations of the Building Department of the City of Atlantic Beach, shall be complied with, whether
herein specified or not.
The Contractor or Owner-Builder who has been issued a Building Permit is automatically responsible to ascertain that all sub-
contractors engaged by him are duly licensed in the City of Atlantic Beach,Florida. To prevent delay or embarrasment regard_
Ing intermediate or final inspections it is suggested that a list of sub-contractors be submitted to thL office so that liceames can
be verified,
j11, Date......1 ► ip. .
Owner.... W-----/"! /.... /L7 S
1ArchAddress :...... UIa.Co(ti^pjD..Telephone
--
..61
Architect
itect..._.....---•----•................•-------•---................................................Addres$........ ......---. elephone No..-----•--..._.....-•-Contractor Builder.............. ' - --••---
LotNo.. -- ....... - -•---•--••-------••...................Address---•----•--.._......---....._..._.................---•------Telephone No.............................
_C ---------------_--------------Block No.............I---------------Sub Division----S .¢S l" 1�_ .
-----------•-----•--•-•--- Zone.................
.................
---------••------------------------------------------------Street
-----•-----'Side Between........ ...... ..................................and...............................
Sty.
Valuation j... - .Da -_-For what n
}�-• --- - � purpose will building be used..`�Y.N�L�-�C�!/.��e of construction... -•-
_._ ....
Dimensions of Building.�(�D---h�Qj
-- - ------------Dimensions of Lot.......
/Oct Size of Foo
tom.----.6..... �........
Size of Piers-------------•-•- ---Size of Sills.....----------- .... .--.------_-Greatest Sill Span in ft....
n Type Roof.. !i /!✓ 1 .....
How will Building be Heated?.CC -•. ��4 f fF •-W� Building be on Solid or Filled Ground?......
���'�/�••-_..._._---
Size of Ceiling joists..........----------------------------- Distance on Centers--.----.--�--
------•-----•----•--•--, Greatest Span...... --..........................--
Size Of f[Jfi-cra ~
Size o! Floor Joists-------•-----�`---•--•--•----•-•-•-•-•--, Distance on Centers- --
.................... Greatest Span----_'------.---
.._.-..�f' .� ----•-
Distance on Centers. ...v;:- ---------•-••-•---•---•--, Greatest Span-------.
This rectangle L to represent the lot.
D Locate the building or buildings in the
( A ht position. Give distance in feet from
2lot-lines and existing buildings.
Two copies of plans and 7 REAR LOT LINE
P P specifications shall
be submitted with application. AUG u G 1980
Inspections required.
1. When steel Is in place and ready to pour footing CG
2. When steel is in place and ready to pour colum s ,a�n L�NTIC BEACH z T
3. When steel is in place and ready to pour beam, a
4. When framing is completed, APPROVED �1
h lamb CITY OF !TL^NTIC BEAM
5. When rough plumbing is completed,and ready to cover up. BUILDING OFFICE
6. When septic tank drain field or sewer is laid but before it is erect. �� � W
7. Electrical inspection by City of Jacksonville. 3 8 Q
8. FinalO0
Inspection.
Note: In came of any rejection,re-inspection MUST be calledf
corrections are made. 9
In consideration of permit FRONT OF LOT
pe given for doing the work as described in the above statement, we hereby agree to perform said
work In accordance with the attached DIAM and specifications,-Fhich are a part hereof, and in accordance,with the building
regulations of the City tlan c e
Signature of Builder.
Address... ,{�
......................
Signature of Owner................................................................................_ Address............
CITY Y G4 UAAiRMels G:F-..,01 OV
MATER CONNECTION CHARGE
LOCATION
Az
OWNER., 2
PLUMMING FIRM
MASTER PLUMBER
ffpE $G'lF SUILDXXGI__Jdz��___t,��
ZDA S M604MI GK?&P CGONSIS C I M6 O SiZlWU, T•3 All., A IMPS~i I:• ?1 ;;MICS)
WATER CLOSET LAVATORY 9 BAP!TUB SHOWERS Gf,,.OJP PFR HEAD 3 Vli
P4t,47M (WITH Six% WITHOUT OVER
- PEI DET ,"3 vni t ; .._.�_. FLUS INN RIM SINK (tit l is a
COKUMT1,CM SXNK ANN TRAY (3 4.^nit'o) ����ll�:� SIMM.!, T�.�#,�i�rSTAll- (3,, imlat 1
6.`i�a�lr`��S�t@Y:~5.�.6�i6 SIN41 AND TRAY F►/FlOOD 0M �tid ; 11,�.��LEk'*l S K 1,;,t4 units)
_ORI At' L. PEDESTAL,
55�1�9,1f�'. eilad
41�1R 'll ..+ a f6.. unit) luo- o r onits)
DENTAL UVATORY (I ur�lt) URINAiL, WALL LIP (4 unlit-.$)
DR- NKeN'G F"GUNTP eye (3t, Ud,) 4€ ORAL STALL, WASHOI (r wrl ts)
D SHWAN-HER o2 tinyis + _..._ UPINAL `sR06 4 EACH
_ �t i l
l9
UTCYPEN SAN. WIFOOD WAMI'. UGPIMOE w$t4
WkHl CLOSETS, TANK CSP (4 units)
LAVA i ORY wJ- 0
ICILOSETS, VALVE OP (8 Mlits-)
__ . ..(2 umits), ._..._ LAUNDRY TRUA ' units'j
CITY CF ATLANTIC BEACH
716 OCEAN BOULEVARD
ATLANTIC BEACH, FLORIDA
ADDED UM TO BUILDING PIAN
1. Building Ld--aticn.;
J
2. The attached plan for the above building is approved subject to meeting the following
applicable construciton requirements:
a. Footings shall be continuous monolithic concrete under exterior walls, reinforced
with two 5/8" deformed reinforcing rods for one-story buildings and three 5/8"
deformed reinforcing rods for two-story buildings. Reinforcing rods shall be
placed in the lower one-this of the footings, properly placed and fastened on
metal cables with wire. Footings shall be six inches wider on each side than the
wall above, shall be at least eight inches thick and shall rest on firm soil at
least twelve inches below undisturbed soil.
b. In hollow masonry unit construction, each unit cell shall be reinforced with at
least on No. 4 bar at all corners, poured and tamed with concrete; such rein-
forcing shall be properly tied into the footing and spandral beam.
c. All wood truss rafters (roof construciton) , shall be securely fastened to the
exterior walls with approved hurricane anchors or clips.
d. Construction of nearby one-family dwellings, which are duplicates or intensely
similar, shall be avoided. Such similarity considers the external configuration
and appearance (i.e., roof, outer wall materials, window size and design, and
other like characteristics) of structures. In accord with the foregoing, similar
or duplicate homes shall not be constructed within close proximity of each other,
and shall be at least 500 feet apart if any one similar dwelling is visible from
any other similar dwelling.
e. The final connection between the house plumbin and the service
connection (at the property line) must be by the fore being
covered. -
City 9
The undersigned hereby certifies that he has read the above and understands that this
addendun takes precedence over any contrary details to the plans and specifications
and agrees to carply with the intent of this addendum.
Contractor/Owner
g- -:226,
Date
DEPARTMENT OF BUILDING 4 4 9 2
CITY OF ATLANTIC BEACH, FLORIDA PERMIT NO.
PERMIT TO BUILD
THIS PERMIT MUST BE POSTED ON JOB
Date-repe�*�er—=`y =�-
I Valuation $ t 1 uf_iili rt c, Fee $ 11.00
This permit not valid until above fee has been paid to City Treasurer, and is
subject to revocation for violation of applicable provisions of law.
This is to certify that lion Harris Plumbimz Co
has permission to IMM indtal I 1 sink 9 1 avatnri Pg�1 hath ttrh 9 r1_C1SPfq,
1 shower, 1 water heater,l dishwasher,l disposal,l washing awch
Classification Residential lone
Owned by__ I1ew Mat ('n
Lot-.... Block S/D
House No. 517 Vikinc_,n 1a,l„
According to approved plans which are part of this permit
NOTICE—ALL CONCRETE FORMS
AND FOOTINGS MUST BE IN-
SPECTED BEFORE POURING.
E PERMIT VOID SIR MONTHS
�I AFTER DATE OF ISSUE
I —� ► O Building material, rubbish and debris
?,I from this work must not be placed in
public space, and must be cleared up
and hauled away by either contractor
or owner.
Bill If.6 jbavi i 9 j
Building official..-.
FOR OFFICE PERMIT
USE ONLY NUMBER DATE CONTRACTOR I46ivI
PLUMBING
c
ELECTRICAL
SEWER
WATER
v/'
f
� o �/�
CITY OF ATLANTIC BEACH
qAPPLICATION FOR PLUMBING PERMIT
Date L/1)O
Location
Plumbing Finn
1
Master Plumber -
City/County Occupational License No.
State Certificate No.
Builder or Contractor Put
Type of Building
SINKS _SHOWERS
LAVATORY t WATER HEATERS
BATH TUBS _DISHWASHERS
URINALS _DISPOSALS
CLOSETSWASHING MACHINE
FLOOR DRAINS
OTHER
TOTAL FIXTURE COUNT I I C1(
INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH THE MDST
RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE.
CITY OF ATLANTIC BEACH
APPLICATION FOR WATER CUT-IN
APPLICATION IS HEFEBy NADE FOR `�/ WATER CUTIN AT
THE FOIZaWIlNG ADDRESS FOR / UNIT (S)
CUTIN CHARGE OF Zo y-,?,60
STREET NO.
LOT r' BLOC�C SUBDIVISION
ACCOUNT NO.
VASTER PLUMBER
NAILING ADDRESS
DATE 2- 2 3- , d
NSR No.���- DATE INSTALLED 9 2- 3
CITY OF ATLANTIC BEACH
APPLICATION FOR SEWER MONS
ACCOUNT NO.
DAA -�Q
LOCATION
LOT NO.- BLOCK NO. SUBDIVISION
OWNER
TYPE OF BUILDING
411
MASTER PLUMBER
DATE
INSPECTED BY
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