117 DONNER RD - PLUMBING �et' . ��, CITY OF ATLANTIC BEACH
Ai ) 800 SEMINOLE ROAD
j,._, -. _ ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
r 1131,?
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-2033
Job Type: PLUMBING ONLY
Description: PLUMBING - 12 FIXTURES
Estimated Value:
Issue Date: 8/27/2015
Expiration Date: 2/23/2016
PROPERTY ADDRESS:
Address: 117 DONNER RD
RE Number: None
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: $143.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITII ALL CITY OF ATLANTIC BEACH ORDINANCES AND 771E FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
1�
Ph(904) 247-5826 Fax(904)247-5845 1 5 - P L Bf; - 2033
JOB ADDRESS: r rA PERMIT# 1Cj'N5U\"I51 I
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE Q n'
Bathtub Septic Tank&Pit _
Clothes Washer Shower 0
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 4
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers •
Laundry Tray Water Connected Appliances
Lavatory G 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 violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name Phone Number
Plumbing Company Cp,ny�J \iv,u ,1v-,c. Office Phone 7(4-(-G o Faa l-U1-0-41G
Co. Addreo� +► ;p7 City�,c�{-rc�A;,ll.L StatecL Zip 3 11
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Licen� i" ,' (... 61_1.4,-7 State Certification/Registration# «c- "12-C('-C O
oasy 9,?oi o� 's
Notaisz�natufec'pffense Holder
=* s = 1n) /
v; Of 08227o 4p Sworn and subscribed before me this o/ " day of 0 20 )5
;:9).... '.aibi, ....<<%' Signature of Notary Public ��l/