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
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Application desc
DISCONNECT SEWER
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Owner Contractor
-
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FANNIE MAE METRO ROOTER
ONE WEST BANK FSB 8892 NORMANDY BLVD
888 WALNUT ST E JACKSONVILLE FL 32221
PASADENA CA 91101 (904) 695-1911
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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
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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.
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.