375 4th St 2014 water main to home l r3 yL�J f fug
�� � � CITY OF ATLANTIC BEACH
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800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000865 Date 5/29/14
Property Address . . . . . . 375 4TH ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 0
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Application desc
WATER MAIN TO HOUSE
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Owner Contractor
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BENNETT, STUART N & PHYLLIS W PROFESSOR
LANPLUMB
TIC BLVD, #247
375 4TH ST 1015
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 270-2266
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Permit . . . . . . PLUMBING PERMIT
Additional desc . . . 00
Permit Fee . . . . 62 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 11/25/14
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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
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Permit Fee Total 62 . 00 62 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 66 . 00 66 . 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: 3� +� Sfi- b 1 _ 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 Qom'
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:
XSewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well
**SIR WD Well Completion Form. Completed/form to be submitted to the Building Department for final inspection.**
Other14'T� f�rFj�v To l'fi0�S�C
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 constriction or the performance of construction.
Property Owners Name 5- (/� r� Phone Number
Plumbing Company /' Zt'S Som ` v b Office Phone 270'2Z(6� Fax �f 7S OLS3
Co. Address: �� t*w X/G �V City State&Zip .3t2 33
License Holder(Print): 254-NES T_ /" e! 646 t • State Certification/Registration# qtr / ONO,
Notarized Signature of License Holder
Sworn and subscribed before me this day of 20
Signature of Notary Public