700 Triton Rd 2014 Plumb CITY OF ATLANTIC BEACH
S 800 SEMINOLE ROAD
J X ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
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Application Number . . . . . 14-00000230 Date 2/21/14
Property Address . . . . . . 700 TRITON RD
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
7 FIXTURES
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Owner Contractor
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LOPEZ IRIS M TRUST ALL PHASES PLUMBING
5824 REBA ST 865 SAILFISH DR
MORTON GROVE IL 60053 ATLANTIC BEACH FL 32233
(904) 773-3985
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Permit . . . . . . PLUMBING PERMIT
Additional desc . . . 00
Permit Fee . . . . 55 . 00 Plan Check Fee
Issue Date . . . . 2/18/14 Valuation . . . . 0
Expiration Date . . 8/17/14
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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 55 . 00 55 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 59 . 00 59 . 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 - 45
JOB ADDRESS' ' C �tG� 3 2?3 PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$J�ot�
TYPE of FIXTURE QTY TYPE of FIXTuRE Qry
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 j
Other Fixtures Water Treating System
RE-PIPE:
TYPE of F/XTURE 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 "
**SIRWD 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.1 hereby certify that 1 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 authonn'q to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name /U`S Phone Number
Company AA. cx��,��,,i-� Office Phone) d �Fax—
Plumbing
Co.Address: 1 Z5 �+t�i�rK�C Lit+` - City_jW aALJriL State J Zip X 33—
License Holder(Print): State Certification/egistmtion# 11'G S
Notarized Signature of License Holder A 004-0`
Before me this ay of f�) 2
Mr ca►o essron#FF m1480
f j a„uE IREi+S: 244.20117 Signature of Notary Public
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