1969 Brista De Mar 2014 Plumb yL,fr1N C, v�
's� CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000830 Date 5/20/14
Property Address . . . . . . 1969 BRISTA DE MAR CIR
Application type description PLUMBING ONLY
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 0
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Application desc
3 fixtures
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Owner Contractor
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KANE, PHILIP B F.W. FAIR PLUMBING CO.
1969 BRIST DE MAR CIR P.O. DRAWER 51558
ATLANTIC BEACH FL 32233 JACKSONVILLE BEACH FL 32250
(904) 241-7191
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 76 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 11/16/14
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Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 76 . 00 76 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 80 . 00 80 . 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
/ax (904�0)y}2/4�7n-5845
JOB ADDRESS: .� oe& 1" PERMIT14MA
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 T Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory _L 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
**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 a provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name Phone Number
Plumbing Company ) Office Phone l —Fax
Co. Address: ^ City rls State ZiV
t– PA l State Certification/Re istration &d D ? 7 1 r.J
License Holder(Print): g
Notarized Signature of License Holder
"'" . JENNIFER WALKER Before me this 2 &&-.,day of I ^I20
41' ': V V
MY COMMISSION N FF Ot 1480 l/V
g. EXPIRES:April 24,2017 Signature of Notary Public
Bonded Thru Notary Public Underwriters g ^