370 SARGO RD PLBG 2016 r s CITY OF ATLANTIC BEACH
"" 800 SEMINOLE ROAD
±� " ;s' 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: 16 -PLBG -525
Job Type: PLUMBING ONLY
Description: PLUMBING - 14 FIXTURES
Estimated Value:
Issue Date: 3/4/2016
Expiration Date: 8/31/2016
PROPERTY ADDRESS:
Address: 370 SARGO RD
RE Number: 171689 -0000
PROPERTY OWNER:
Name: MACDOUGALL, DAVID A
Address: 370 SARGO RD
GENERAL CONTRACTOR INFORMATION:
Name: CANNON PLUMBING, INC.
Address: 1794 -1002 ROGERO RD QA OLIN MARSHALL CANNON
Phone: - -
FEES:
Plumbing Fixtures $98.00
Trade Permit Base Fee $55.00 --l-
L.
State PLMG DBPR Surcharge $2.00
c / C)-
State PLMG DCA Surcharge $2.00
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 I / p f _ 5 z5
Ph (904) 247 -5826 Fax (904) 247 -5845 �--t`
JOB ADDRESS: -2 0 ,Car o e PERMIT # IC S FR"o1g'541
NEW OR REPLACEMENT INSTALLATION: Project Value $ t F 0 1 1 -1, 0 9s
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 1 Septic Tank & Pit
Clothes Washer Shower 1
Dishwasher { Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet a.
Hose Bibs a. Urinal
Kitchen Sink I Vacuum Breakers .
Laundry Tray Water Connected Appliances 1
—
Lavatory 3 s Water Heater t
Other Fixtures Water Treating System
RE-PIPE: l \ / ,
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 Vacu Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures - Water Treating System ,,,
MISCELLANEOUS:
o Sewer Replacement o Back Flow Preventer o Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
o 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 void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that T 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 pr visions of any other state or local law regulation construction or the performance of construction.
Property Owners Name a-L. O1oL a 1 I / 0 aka A. Phone Number
Plumbing Company Cr n n Q n Oh. 0,1 .1, 4 ,1+%6 Office Phone 1'04-70= 6 3CRS Fax 104- 5S1 041 G
Co. Address: ) E. C--1.-) 0-re, Y1 54 City Jack-5or1 r J(' State pc_ Zip ?
License Holder (Print): _ (2 L/' CA-0J b d State Certification/Registration #
Notarized Signature o, f License Holder --- .
4.46_,)-LESLIE DALE Sworn and subscribed before me this / day of
rn - h 20 1 ( e
4? _t Oa� .to mmission # FF 144322
yy �� tr �
• J• :4 , l' `::'1 i . 1 ��,,, . 23. 2015 Signature of Notary Public
- p I S iwacra 8 00.385 -7015 b""�