1912 Selva Marina Dr 2015 PLBG If
` , CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
:} ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-308
Job Type: PLUMBING ONLY
Description: INSTALL 14 FIXTURES
Estimated Value:
Issue Date: 2/10/2015
Expiration Date: 8/9/2015
PROPERTY ADDRESS:
Address: 1912 SELVA MARINA DR
RE Number: 169462-0110
PROPERTY OWNER:
Name: WERNKE, BARBARA
Address: 1912 SELVA MARINA DR
GENERAL CONTRACTOR INFORMATION:
Name: CANNON PLUMBING, INC.
Address: 1794 -1002 ROGERO RD QA OLIN MARSHALL CANNON
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $98.00
Trade Permit Base Fee $55.00
Total Payments: $157.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax(904)247-5845
JOB ADDRESS: /G/ Z S'L A4 POO_10 Pr S1- PERMIT#
NEW 'ael
OR REPLACEMENT INSTALLATION: Project Value$ &b
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 'V Septic Tank&Pit
Clothes WasherI Shower 1
Dishwasher �— Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs �1 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 the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name Ni£K Tt M a£ N ` Phone Number 9/3- 7-53 a T2
Plumbing Company t'ia� 1`J C Office Phone '7 (0 3 S� Fax
City r76t State Zip
Co. Address: State Certifcation/Registration#L�C/ Z6/`�c)
License Holder(Print): Cao�
Notarized Signature of License Holder
Before me this 'J day of FEB 20 --
:. n;miss�an r FF tai;:; 2 Signature of Notary Public
expires 1u.; !6E'X1'P'T-i1f`e`s1sJ
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