1767 seminole Rd 2014 plumb CITY OF ATLANTIC BEACH
l 800 SEMINOLE ROAD
z N� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00001494 Date 9/10/14
Property Address . . . . . . 1767 SEMINOLE RD
Application type description PLUMBING ONLY
Property Zoning . . . . . . . RES GEN 2F DISTRICT
Application valuation . . . . 0
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Application desc
11 fixtures
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Owner Contractor
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------------------------ ---------- -
JERPBAK, DONALD M BILL FENWICK PLUMBING
1767 SEMINOLE RD 11623 COLUMBIA PARK DR E
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32258
(904) 242-0444 (904) 724-7022
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Permit PLUMBING PERMIT
Additional desc Plan Check Fee . 00
Permit Fee . . . . 132 . 00 0
Issue Date Valuation
Expiration Date . . 3/09/15
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Other Fees
_ STATE PLBG DCA SURCHARGE 2 •
STATE PLBG DBPR SURCHARGE 2 . 00
Fee summary Charged Paid Credited Due
_ ----------
--------- ----------
----------
- . 00
Permit Fee Total 132 . 00 132 . 0000 00 . 00
Plan Check Total • 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00
Grand Total
136 . 00 136 . 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: 13(01 �1QP � _PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$tL41 LA S5-Do
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 21 Urinal
Kitchen Sink l 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
eriod or work is suspended or abandoned for six months.I hereby certify that 1 have read
Permit becomes void if work does not commence within a six month p
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 er Phone NumbergL -2q2-'D4yq
Plumbing Company
VIS
�e �-� 1 ��nG Office Phone 04--70q"16ZZFax -7
Co. Address: 111223 C�� �� �C�C fir' C City J �)( State —t-1 Zip 3-2-L2152—
License
225License Holder(Print),\WC1Fn State Certification/Registration#
NotRM
e o 'c s der , lCFehefo4r-ee
Public CState um of Florida worn and subscr L�_day of 20
T Slomission EE070747 03/06/2015 ignature of Notary Public