42 11th St Plumb repipe (40 & 42) St, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
-r ATLANTIC BEACH, FL 32233
= INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000270 Date 2/24/14
Property Address . . . . . . 42 11TH ST
Tenant nbr, name . . . . . . 40 & 42
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
-----------------------------------------------
Application desc
19 FIXTURES
----------------------------------------------
Owner Contractor
-
------------------------
-----------------------
TUCKER ADELAIDE R TRUST STEEG PLUMBING
42 11TH ST 1601 MAIN STREET
ATLANTIC BEACH FL 322335700 ATLANTIC BEACH FL 32233
(904) 249-5191
---------------
Permit . . . . . . PLUMBING PERMIT
Additional desc . . . 00
Permit Fee . . . . 188 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 8/23/14
---------------------
----------------------------
Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 82
STATE PLBG DBPR SURCHARGE 2 . 82
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ----------
---------- --
Permit Fee Total 188 . 00 188 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 5 . 64 5 . 64 . 00 . 00
Grand Total 193 . 64 193 . 64 . 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: y� 77� PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE oFFIXTURE QTY TYPE oFFIXTURE 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 J�
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
WISCELLANEOUS:
:i Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
:i Lawn Sprinkler System-Number of Heads ❑ Well
�*SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection."
I Other
ermit 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
its 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
r 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.
roperty Owners Name ��t
� �3 Phone Number
lumbing Company rce CU A! Office Phone Fax - lW 6r3S/
o. Address: t ' 5)(— City X-o-1-6 Ad State'rcz Zip �V'40-ar
icense Holder(Print): a/-M J, State Certification/Registration#
r
otarized Signature of License Holder
i
Sworn an subscribed efore day of 2
ssE S ature of Notary Public
DEDOWAkft
`8mIRES:May21,2015
bru Ndwy pW*Underwr,,,,