1763 E Park Ter 2014 Plumb CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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Application Number . . . . 14-00000535 Date 4/08/14
Property Address . . . . . . 1763 E PARK TER
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
repipe 12 fixtures
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Owner Contractor
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HAGIST TRUST, JULIETTE B TDG PLUMBING
1763 PARK TERRACE EAST 4426 LOYS DRIVE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32246
(904) 545-7341
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Permit . . . . . . PLUMBING PERMIT
Additional desc .
Permit Fee 139 . 00 Plan Check Fee . 00
Issue Date . . . Valuation 0
Expiration Date . . 10/05/14
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Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 09
STATE PLBG DBPR SURCHARGE 2 . 09
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Fee summary Charged Paid Credited ----Due---
----------------- ---------- ---------- ------
Permit Fee Total 139 . 00 139 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 18 4 . 18 . 00 . 00
Grand Total 143 . 18 143 . 18 . 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 22
800 Seminole Rd Atlantic Beach, FL 32233 DJ
Ph(904) 247-5826 Fax(904) 247-5845 '
JOB ADDRESS: (, ,, PArTe�rt'A Ce J-� 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 Shower
—
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Toilet Compartment Sink
Floor Sink
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
or 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.
Property Owners Name CJ : LU,^rid '~ Phone Number
Plumbing Company—= G Pl. ,`��, Office PhoneJ5ls�• 7��� Fax '� ���'
Co. Address: City�H StateFL Zip- 2
License Holder(Print): I D C i ne State Certification/Registration#C f C"(4 L �-
Notarized Signature of License Holder
Before me this ay of 20
Signature of Notary P is