366 Royal Palms dr Plumb 2014 CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00001479 Date 9/09/14
Property Address . . . . . . 366 ROYAL PALMS DR
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
3 FIXTURES
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Owner Contractor
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SALFER, ALLEN R. & ROSE ANN JOHN WILLIAMS PLUMBING, INC.
LIFE ESTATE 109 SOUTH COLLEGE STREET
366 ROYAL PALMS DR MACCLENNY FL 32063
ATLANTIC BEACH FL 32233 (904) 259-4580
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 76 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 3/08/15
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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 (904) 247-5845
JOB ADDRESS:. t�u�( Pct,mS ��1 V� PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value $ —tLAI:50
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
Diishiwher Shower Pan
Drigg 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 **
** SIR WD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other
Pennitle4us 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 appli ' ion 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 Phone Number AQOyN -r1�"
11 11\\ Q y qoL1
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Plulpbing Company�'S>J�n W����a,�S P t u n� Office Phone - Fax
Co. Address: \U� S ,����. City State'FL Zip O(D
License Holder(Print): /State Certification/Registration# CVC Q5(dC1(o i
Notarized Signature of License Holder
IN 11111''Itio''
E%t.j
Notary Public State of FloridaSworn and subscribed before m this_ ij 1 day of p K%�r 20�Sandy Hines
My Commission EE 155300 Signature of Notary Public
Expires 12/26/2015