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130 Seminole Rd 2014 sewer CITY OF ATLANTIC BEACH St1 800 SEMINOLE ROAD ..J � ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 14-00000628 Date 4/22/14 Property Address . . . . . . 130 SEMINOLE RD Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ----------------------------------------- Application desc DISCONNECT SEWER ---------------------------------------- Owner Contractor - ------------------------ ----------------------- FANNIE MAE METRO ROOTER ONE WEST BANK FSB 8892 NORMANDY BLVD 888 WALNUT ST E JACKSONVILLE FL 32221 PASADENA CA 91101 (904) 695-1911 -- ------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . Plan Check Fee . 00 Permit Fee 69 . 00 . Valuation . . . . 0 Issue Date . . . . Expiration Date . . 10/19/14 _ ------------------------------- Other Fees STATE PLBG DCA SURCHARGE 2 . 0 STATE PLBG DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ---------- --------- ---------- 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. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904) 247-5826 Fax (904) 247-5845 JOB ADDRESS: � J'e ��•��\�- 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 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.** 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. Arc�t�••t� I a-�� W 0.t • ne Number�5�•ry Property Owners Name �• ax �i? Plumbing Company ��� '.4Jb SV tS O•ff e"Phone�3•"t��� �� F '��� `� p�,U City _SPA'c%� A(_StateV\Zip 3��\ Co. Address: �•� License Holder(Print): O� �'' State Certification/Registration#t;�t Notarized Si natureofof Li�Holder 1naY p�'•. DIANNA L.TYSON Swo a scribed before me v�2 of p r' 1 20�— ;'2P� `� Notary Public-State of Florida • .•= My Comm.Expires Jul 6.2016 Signa u e of Notary Public - `; Commission#E EE 186867 %F Bonded Through National Notary Assn.