130 CLUB DR - PLUMBING rr .
V iy\'' �s-J, \Ak
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
D� }-y 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-2888
Job Type: PLUMBING ONLY
Description: 22 FIXTURES
Estimated Value:
Issue Date: 12/14/2015
Expiration Date: 6/11/2016
PROPERTY ADDRESS:
Address: 130 CLUB DR
RE Number: 170319-0000
PROPERTY OWNER:
Name: Shields, David
Address: 53 Oceanside DR
GENERAL CONTRACTOR INFORMATION:
Name: CANNON PLUMBING, INC.
Address: 1794 -1002 ROGERO RD QA OLIN MARSHALL CANNON
Phone: - -
FEES: — - - — --- - -- _
Trade Permit Base Fee $55.00
Plumbing Fixtures $154.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Total Payments: $213.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 •
Ph (904) 247-5826 Fax (904) 247-5845 15 -SFR-A3,2,7
JOB ADDRESS: / 30 C1(411) Dr I've,/ A-1-10"-1-4, I3 L 4CAt FL. 3..233 PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ V-490 . 595
TYPE OF FIXTURE QTY TYPE OF FIXTURE
QTY
Bathtub 3 Septic Tank& Pit
Clothes Washer I Shower I
Dishwasher I Shower Pan •
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet If
Hose Bibs I Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray I Water Connected Appliances A.
Lavatory 5' Water Heater I
Other Fixtures Water Treating System I
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:
❑ Sewer Replacement ❑ Back Flow Preventer 0 Grease Interceptor (Trap) _gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads o Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other
Permit becomes voia 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 liitpw 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 Ga.', not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name Jebel h i 4,— + CI■44.S /,1;1 I Phone Number 7 elf- G 486-1-g l 8
Plumbing Company C a nno✓I at rn1 ;„
.�-n!, Office Phone 90�-7µ4_(,3Sp�Fax 90_ SS'1-c��}tC
Co. Address: ITT E. Ch tArc h .S-{- City /At-lc-son tr,lle State /L Zip 3aai5A.
License Holder (Print): 0 it rl Ca nn mel State Certification/Registration # C Fe Ilia 6 l 1/-,Z
Notarized Signature of License Holder
•ViNt%' LESLIE DALE Sworn and subscribed before me this_ 3, day of ,De carte b� 20 /c
Ay'` . Commission#FF 144322 ) Q —
j. 1 Expires July 23,2018 Signature of Notary Public d�..... �`-
ys `. Bonded Theo iioy Fin insurance 800385.1019