384 1ST ST - PLUMBING fir,'
CITY OF ATLANTIC BEACH
~ J 800 SEMINOLE ROAD
,V ti 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-2753
Job Type: PLUMBING ONLY
Description: PLUMBING - 17 FIXTURES
Estimated Value:
Issue Date: 11/25/2015
Expiration Date: 5/23/2016
PROPERTY ADDRESS:
Address: 384 1ST ST
RE Number: 169755-0000
PROPERTY OWNER:
Name: MARCO, DAVID
Address: 2339 OCEAN BREEZE CT
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 $119.00
Trade Permit Base Fee $55.00
Total Payments: $178.00
I'ERNIIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 i< _Yi r/L - L 2-'.7 •
Ph (904) 247-5826 Fax (904) 247-5845 '
� a `� i'S� ., t5- - pL _ n53
JOB ADDRESS: `.ii_ PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
•
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher .k - Shower Pan •
Drinking Fountain '\ Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs " Urinal
Kitchen Sink T— Vacuum Breakers
Laundry Tray . 4 Water Connected Appliances
Lavatory _ Water Heater
Other Fixtures Water Treating System
\
RE-PIPE: ' \
TYP,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:
D Sewer Replacement o Back Flow Preventer z Grease Interceptor(Trap) _gallons(Requires 3 sets of plans)
Lawn Sprinkler System-Number of Heads C Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
Other
Permit becomes voila 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 lwpw 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 uaz not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
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Property Owners Name �°'�' t � Phone Number 7114/6.1.5a
Plumbing Company (tt',it,'t 4t i�,+1 Si��, )n L Office Phone 7 L/(./&:-`' Fax
Co. Address: l 41`(' L /� t b /L 1 City 3-.)-7---- State It Zip iLi 1/
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License Holder(Print):r`i `2 '+'+ ''i State Certification/Registration# (7 4/`i'24e/0
Notarized Signature of License Holder
-Al.:'*! worn and subscribed before me this '.'f.,., .�
,:�.� LESLIE DALE —/-'I�;�,�!��,.'M:�.��ni �.ems;,-i�
.. '_ Commission#FF 144322 _ ` tttli;1o1 ex
,;,... Expires July 23,2018 Signature of Notary Public G •' l ,;it.".A..iLfdttlii
!CRo•L', Bonded Thu Troy Fan Murano 800385-70/9 - -,f