115 DONNER RD - PLUMBING Nsf CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
\ INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
30B INFORMATION:
Job ID: 15-PLBG-2031
Job Type: PLUMBING ONLY
Description: PLUMBING - 12 FIXTURES
Estimated Value:
Issue Date: 8/27/2015
Expiration Date: 2/23/2016
PROPERTY ADDRESS:
Address: 115 DONNER RD
RE Number: 172150-0000
PROPERTY OWNER:
Name: THOMAS. ELSIE LYNN
Address: 1964 FRANCIS AVE
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 $84.00
Trade Permit Base Fee $55.00
Total Payments: $143.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845 1 5 PL 6 G - Z o31
JOB ADDRESS: 1\ C ny,e_,r1Thi-.Gt:•\ PERMIT# 1 \- ;4151\
• NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY •
Bathtub 0 Septic Tank& Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet Li
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers °
Laundry Tray Water Connected Appliances
Lavatory = Water Heater Q
Other Fixtures 0 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 0 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.**
D Other
•
'emit 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
his 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
)r 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.
koperty Owners Name Phone Number
lumbing Company CorircR , ,, ct lt,,(--. Office Phone
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�icen �lE� •sia int .� Ul• �..e ..g... �--r State Certification/Registration# </�G ("IZ I��
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Votn z,i gnaturegprense Holder �
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o: OFF 082270 oz Sworn and subscribed before me this of - day of Atterd4 20 ij
'' i-�.*... S...,.°, Signature of Notary Public %
joffit f.t l lN1„.