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358 Royal Palms dr 20134 Plumb CITY OF ATLANTIC BEACH s) 800 SEMINOLE ROAD j ATLANTIC BEACH, FL 32233 PLUMBING PERMIT INSPECTION PHONE LINE 247-5814 •"'��`' ALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 30B INFORMA Job - - 3ob Type: PLUMBING ONLY Description: 12 fixtures Estimated Value: Issue Date: 10/15/2014 Expiration Date: 4/13/2015 PROPERTY ADDRESS: Address: 358 ROYAL PALMS DR RE Number: 171712-0000 PROPERTY OWNER: Name: CHAPMAN, MARK B Address: 358 ROYAL PALMS DR GENERAL CONTRACTOR INFORMATION: Name: FLOW SOLUTIONS INC Address: Phone: - - FEES: State PLMG DBPR Surcharge $2.00 State PLMG DCA Surcharge $2.00 Plumbing Fixtures $84.00 Work W/O Permit Plumbing $84.00 Total Payments: $172.00 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(9,044) 247-5826 Fax (904) 22Q4,7-58455 JOB ADDRESS: 7 /�11� P�i�S D�</���� G�=oeA& V233 PERMIT# NEW OR REPLACEMENT INSTALLATION: Project Values TYPE of FIXTURE QTY TYPE of FIXTURE QTY Bathtub _ Septic Tank&Pit Clothes Washer Shower , Dishwasher L_ 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.** ❑ 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 violates the provisions of any other state or local law regulation construction or the performance of construction. Property Owners Name Phone Number 70Y 90'Y-3_777 Plumbing Company -1C \�\,,—I Office Phone Co. Address: �� 5 `�P�y�_�'O�` ,1 S-0 City `-�� Stated Zip License Holder(Print): �- �= �' �Z 1 \` IN State Certification/Registration# ty�1 4 c7 Notarized Signature of License Holder p ,,/, Sworn and subscribed befor a thi ay of ��/�- 20�( � Signature of Notary Public �' I