475 Palmwood Ln 2014 Plumb CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
r, ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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Application Number . . . . . 14-00000336 Date 3/11/14
Property Address . . . . . . 475 PALMWOOD LN
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
2 fixtures
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Owner Contractor
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NELLIS RICHARD E NELSON PLUMBING CO. INC.
475 PALMWOOD LANE 11624-1 DAVIS CREEK ROAD E
ATLANTIC BEACH FL 322335607 JACKSONVILLE FL 32256
(904) 262-4884
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Permit . .
. PLUMBING PERMIT
Additional desc . . . 00
Permit Fee . . . . 69 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 9/07/14
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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
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Permit Fee Total 69 . 00 69 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 73 . 00 73 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
FROM FAX NO. :9048238736 Mar. 11 2014 07: 12AM P1
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 V�
Ph(91004—) 247•-5826 F/� (904 47-5845 I �
JOB ADDRESS:ADDSS: r� � 1 `/V( ` wcx2 l 1� � -� PFERN)(? {�wo f
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NEW OR REPLACEMENT INSTALLATION: Project Value
TYPE of FixTURE TYPE oF FrxruRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Sktower
Dishwasher - Shower Pan
Drinking Fountain Slop Sink
Floor brain Three Compartment Sink _
Floor SinkToilet
Hose Tubs �µ Urinal
Kitchen Sink _ Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE
TYPE of Fixime Q!'Y 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
IoItchen
Bibs _ Urinal
tchen SinkVacuum Breakers
Laundry Tray _. Water Connected Appliances
Lavatory Watdr Heater
Other Fixtures Water Treating System
NUSCELLAMOUS:
❑ Sewer Replacement C-3 Back Flow Preventer n Grease Interceptor(Trap) gallons(Requires 3 sets of plf
❑ Lawn Sprinkler System-Number of Heads ❑ Well
** SJ.RWD Well Completion Form. Completed or�m to be submitted to the Building Department for final inspectior.
❑ Other --
Pcrmit 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
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 spec!
or not. The permit does not give auth •ty to latt the provisions of any other state or local law regulation construction or the performance of eonstructic
Property Owners Name v 15— A i Phone Number
Plumbing Company ___V QfMce Phone Fax_,Z9Z,_
Co. Address: �� D4J)J's fity Stater_ zip3
License Bolder(Print): tate Certification/Registration *Cr`L'o20_y1
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<'." Notary Public-state of Florida
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