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440 Osprey Key 2013 Plumb 1r� CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 011 a? Application Number . . . . . 13-00003830 Date 12/12/13 Property Address . . . . . . 440 OSPREY KEY Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ----------------------------------------------------------------------- Application desc 10 FIXTURES ---------------------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- JACKSON EDMUND W JR HOFFMAN PLUMBING II INC. 440 OSPREY KEY CHRISTOPHER E HOFFMAN ATLANTIC BEACH FL 322334367 P.O. BOX 65058 ORANGE PARK FL 32065 (904) 282-9433 --------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee 125 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 6/10/14 ------------------------------------------------------------ Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00 STATE PLBG DBPR SURCHARGE 2 . 00 --------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 125 . 00 125 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 129 . 00 129 . 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: —V0�:( 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 _J — Shower -- Dishwasher Shower Pan Slop Drinking Fountain Sp 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 ** ** SJR WD 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 p anFi y of construction. or not. The permit does not give authority to violate the provisions of an other sta or 1 IIJJ Property Owners Name C Phone Number Plumbing Company In Office Phone Fax Co. Address: 3°►IV �4t/GAr4n City , State_ Zip 3 i 0 6S License Holder(Print): S /t S ate Certification/Registration# CFC,112-7111 5-4, Notarized Signature of License Holder JENNIFERWALM(E�R' Before me this 1-day of - / 20�3 . MY COMMISSION#FF : ,:, EXPIRES:April 24,2017 Signature of Notary Public Bonded Thu Notary Public Underwriters