369 3rd St 2014 REpipe CITY OF ATLANTIC BEACH
y 800 SEMINOLE ROAD
r� ATLANTIC BEACH,FL 32233
� - INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000641 Date 4/23/14
Property Address . . . . . . 369 3RD ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 0
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Application desc
REPIPE
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Owner Contractor
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EILERS, ELIZABETH T WILLIAM' S BIG BOY PLUMBING INC
369 3RD ST 516 SOUTH 11TH AVE
ATLANTIC BEACH FL 32233 JACKSONVILLE BEACH FL 32250
(904) 241-1880
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Permit . . . . . . PLUMBING PERMIT
Additional desc . . Plan Check Fee . 00
Permit Fee . . . . 90 . 00 0
Issue Date Valuation
Expiration Date . . 10/20/14
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2 . 00
Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE
STATE PLBG DBPR SURCHARGE 2 . 00
_ ________ ----
Fee summary Charged
Paid Credited Due
--
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- . 00
Permit Fee Total 90 . 00 90 . 00 00 . 00
Plan Check Total . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00
Grand Total
94 . 00 94 . 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�904C)`2.47-5826 Fax (904) 247-5845
JOB ADDRESS: 3 3 L_`s ` `' 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 l 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
** SJRWD 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 L a w I S r S Phone Number
Plumbing Company VA22 Office Phone ?N(-f$YO Fax__! —
tJ t ��
City TC-)C 5C L State r Zip 3 t 2 s''c)
Co. Address: �CP
License Holder(Print): �� /J'�''� � � State Certification/Registration# (2F�6470�
Notarized Signature of License Holder �3 ,
Before me this day of � � 20
•'o.""i••. JENNIFER W&*R
=: MY COMMISSION#FF 01141 Signature of Notary Public
:.:
� EXPIRES:Apri124,2017
Bonded Ttuu Notary Pudic UnderwrWers