870 MAIN ST - PLUMBING � s CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
r: Z 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-799
Job Type: PLUMBING ONLY
Description: PLUMBING - 14 FIXTURES
Estimated Value: $30,000.00
Issue Date: 4/5/2016
Expiration Date: 10/2/2016
PROPERTY ADDRESS:
Address: 870 MAIN ST
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 $98.00
Trade Permit Base Fee $55.00
Total Payments: $157.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904)247-5845 I CO –pc,g� -! ci
K7p J OB ADDRESS: 1 l ;Y1 C _
,3��e-c-'� PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ 300 0. o ci
TYPE OF FIXTE,TRE QTY TYPE OF FIXTURE QTY
Bathtub i Septic Tank&Pit
Clothes Washer iI Shower
Dishwasher I. Shower Pan 4
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet a
Hose Bibs Urinal
Kitchen Sink .I— Vacuum Breakers
Laundry Tray Water Connected Appliances 1
Lavatory 3 Water Heater f
Other Fixtures Water Treating System
RE-PIPE: • \lk
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 a Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
O Lawn Sprinkler System-Number of Heads 0 Well **
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for fmal inspection.**
O 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 C a n()c c) U,p JA rn A .T'1C. Office Phone 9QS1'-744-(3535Fax?1Z4 cc)-t.1-1,•Co. Address: /7/g" E t✓A,„,,./r h S-!yes— City S c.�s on v ll t_ State
t3' F Zip 3,12,245.2_
License Holder(Print): a 1 I (_Q n e o n State Certification/Registration# C F C 1 iL.2-6 I*0
Notarized Signature of L icense Holder ..
• ''__i LESUEOALE Sworn and subscribed before frig-this - day of..r4e/r 7 20 /la
_�, ` Commission#FF 144322 Qll
, y_,:: Expires July 23,2018 Signature of Notary Public ().
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CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
PHONE (904) 247-5855
Cashier Id: aspcust\atlblae
Receipt Date: 4/5/22016 3:50:27 PM
Receipt Number: 05-69606
Job ID: 16-PLBG-799 - PLUMBING - 14 FIXTUR
Job ID: 16-PLBG-799 - PLUMBING - 14 FIXTUR
Job ID: 16-PLBG-799 - PLUMBING - 14 FIXTUR
Job ID: 16-PLBG-799 - PLUMBING - 14 FIXTUR
Amount Due: $157.00
Tender Information: Cash $157.00
Tender Type: CC
Tender Amount: $157.00
Change Due: $0.00