357 11th St - Plumbing Permit J �j IrjV�
ss� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
r�roM 9' INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS17-0134
Description: 357 11th St-Will link once GeoRecord is added
Estimated Value: 3000
Issue Date: 10/26/2017
Expiration Date: 4/24/2018
PROPERTY ADDRESS:
Address: 357 11 th St
RE Number:
PROPERTY OWNER:
Name:
Address:
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: CANNON PLUMBING, INC.
Address: 1794 -1002 ROGERO RD QA OLIN MARSHALL CANNON
JACKSONVILLE, FL 32211
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 357
t l
�j Ph (904)247-5826 Fax(904)247-5845
JOB ADDRESS: ?14 54ru+ PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Values -7 Cie 4
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher 1 Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 4-
Hose
Hose Bibs Urinal
Kitchen Sink t Vacuum Breakers
Laundry'fray Water Connected Appliances
Lavatory Water Heater 1
Other Fixtures Water Treating System
RL-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Dram Tbree Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum.Breakers
Laundry"fray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement O Back Plow Preventelr ❑ Grease,Interceptor(Trap) gallons(Requires 3 sets of plans)
D Lawn Sprinkler System-Number of Heads - ED Well **
** SIR WD Well Completion Forth. Completed farm to be submitted to the Building Depaztrneznt for dural inspection.**
❑ Other
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.l hereby certify that X have read
this application and know the same to be true and convect. 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 perf6rmance of construction.
Property Owners Name Phone Number
Plurabing Company_ C,aonon l)" &trn _Office Phone q(bf•-7"-6?90 Fax 0*-8'V 0 ��
Co. Address: „j„'71g 1; a h 5+ City On V.11& State FL Zip 3z�-02
License Holder(Print): Q)) CAn no" State Certification/Registration# CFC14a 414Llf
Notarized Signature of License Holder
=..,E
DALE Sworn and subscribed before me this d-5 dayof Qt4oh"" 20�
ssion#FF 144322 Duly z3�2otie Signature of Notary Public
"TPY fdn InMu�nw A0F9861619
• Receipt Number
• •
City of Atlantic Beach • •
DESCRIPTION
PermitTRAK $207.05
PLRS17-0134 Address: APN: $207.05
PLUMBING $202.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 21 $147.00
STATE SURCHARGES $5.05
STATE DBPR SURCHARGE 455-0000-208-0600 0 $3.03
STATE DCA SURCHARGE 45500002080700 0 $2.02
TOTAL FEES PAID BY RECEIPT: R3288 $207.05
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
10,26,x2011 16:25:40
CREDIT CARD
VISA SALE
Card# XXXXXXXXXXXX9974
SEQ#: 9
Batch#: 471
INVOICE 10
Approval Code: 081688
Entry Method: Marul
Mode: Online
Tax Amount: $0.00
Card Cade: M
ShIE AMOUNT $207,05
CUSTOMER COPY
Date Paid: Thursday, October 26, 2017
Paid By: CANNON PLUMBING, INC.
Cashier: BA
Pay Method: CREDIT CARD 10
'a`
Printed:Thursday,October 26,2017 4:26 PM 1 of 1