380 11th St sewer 2014 CITY OF ATLANTIC BEACH
s 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000501 Date 4/02/14
Property Address . . . . . . 380 11TH ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 0
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Application desc
sewer replacement
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Owner Contractor
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WOOD, THOMAS C & FAYE M DAVID GRAY PLUMBING INC.
380 11TH STREET 6491 POWERS AVENUE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32217
(904) 724-7211
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Permit PLUMBING PERMIT
Additional desc SEWER REPLACEMENT plan Check Fee . 00
Permit Fee . . . . 62 . 00 0
Issue Date Valuation
Expiration Date 9/29/14
Other Fees
STATE PLBG DCA SURCHARGE 2 •
00
STATE PLBG DBPR SURCHARGE 2 . 00
_ ________ ----
Fee summary Charged
Paid Credited ----Due---
_ ------- . 00
--------- ----------
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- . 00
Permit Fee Total 62 . 00 62 . 00 . 00 . 00
Plan Check Total • 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00
Grand Total
66 . 00 66 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION I
CITY OF ATLANTIC BEACH d 1
800 Seminole Rd Atlantic Beach, FL 32233
904
Ph (904) 247-5826 Fax ( ) 247-5845
ITf� - �E .1 PERMIT#
JOB ADDRESS:
�<<G be�� 2233
NEW OR REPLACEMENT INSTALLATION: Project Value$ 1344 1
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
Toilet
Floor Sink Urinal
Hose Bibs Vacuum Breakers
Kitchen Sink Water Connected Appliances
Laundry Tray Water Heater
Lavatory Water Treating System
Other Fixtures
RE-PIPE
TYPE of FIXTURE QTY TYPE of FIXTURE QTY
Septic Tank&Pit
Bathtub
Shower
Clothes Washer
Shower Pan
Dishwasher
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Toilet
Floor Sink Urinal
Hose Bibs Vacuum Breakers
Kitchen Sink Water Connected Appliances
Laundry Tray Water Heater
Lavatory Water Treating System
Other Fixtures
MISCELLANEOUS: gallons (Requires 3 sets of plans)
Sewer Replacement [:1Back Flow Preventer ❑ Grease Interceptor(Trap) **
fk [-i Well
[I Lawn Sprinkler System-Number of Heads
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other
y that I have
Permit becomes void if work does not commence with cta All six of laws aor nd ordinancessuspended
ndgovemmg tor his work will be complied with r six months.I hereby whether specifiedd
this application and know the same to be true and corre p
or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance
f r construction.
np 3 ti yn
� � V)co-� Phone Number '1 �J
Property Owners Name l � �� 1Z�f��j
Office Phone �1 I� 7Z`� L Fax
Plumbing Company T)R1 1p ���� p��N► ` �� J�ra,/l�
Co. Address:
(�4f?/ u.�'f lkie City T State FG Zip 3z_ z 33
License Holder (Print): �`�
State Certification/Registration#
Notarized Signature of License Holder `
- � 20 t�
�*�°w Notary Public State of Florida
Sworn and subscribed before me this 2 day of
Y
A X
LaSheica Wilson
x
Expires commission
2015050523 Signature of Notary Public
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