950 MAIN ST - PLUMBING J�5
j ' v' CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
'. ,t>> INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS17-0140
Description: 10 FIXTURES
Estimated Value: 0
Issue Date: 11/6/2017
Expiration Date: 5/5/2018
PROPERTY ADDRESS:
Address: 950 MAIN ST
RE Number: 170961 0000
PROPERTY OWNER:
Name: AB Main Street Tru t
Address: 8728 1st Avenue
Jacksonville, FL 32 09
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 approv I.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT ' YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPE TY. A NOTICE OF
COMMENCEMENT MUST BE RECO ° 1 ED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECT N. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YO LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTI E OF COMMENCEMENT.
* A notice of Commencement is only required pr work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commenc ment is only required when HVAC work
exceeds and estimated value of$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATI/ANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845 7 L RS 17 y o I
JOB ADDRESS: C S 0 M a i.A S-(-re, ," PERMIT# •
NEW OR REPLACEMENT INSTALLATION: • Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 1 Septic Tank&Pit
Clothes Washer 1 Shower I
Dishwasher Shower Pan • '
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet a-
I-lose Bibs I • Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory a- %- Water Heater .1
Other FuturesWater Treating System
RE-PIPE: 1U
TYPR or Fawn' 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 ❑ Grease Interceptor(Trap) gallons(Requires 3 sets'of plans)
❑ Lawn Sprinkler System Number of Heads 0 Well
**SJRW,D 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 orvvork 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 la ,s 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 oth-' st.te or local law regulation construction or the performance of construction.
Property Owners Name ' 6 IL , S--[ - . ,- Phone Number
Plumbing Company ah lti 9 el
61x tTr\C.,. Office Phone 90*-74{, 63. Fax q N."S/-m!006
Co. Address: 1715' C. c.ht, h _ S--'r "T' City J'ac-1C5onvl'i l State PI- Zip ' dg-.
License Holder(Print):_ 0)in _ Ca-n nod State Certification/Registration# 1 i 4.l_24 0'
Notarized Signature of License Holder
-, ., 0, LE—SUE
ommI Don 1 Sworn and subscribed before me this 1 day of Novi en &r 20 17
*r ..4 Commission#FF 144322 nn , J
y�,'„.`l e=xpires duly 23,8018 Signature of Notary Public u�.[�
rpd,a; BmaadTNUTroyFOlnlnu am200.9864019 .�.�.���.�.............,
,` Cash Register Receipt Receipt Number
4; City of Atlantic Beach R3378
DESCRIPTION I ACCOUNT I QTY I PAID
PermitTRAK $129.00
PLRS17-0140 Address: 950 MAIN ST APN: 1709610000 $129.00
PLUMBING '$125.00
PLUMBING BASE FEE 1455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 10 $70.00
STATE SURCHARGES $4.00.
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
TOTAL FEES PAID BY RECEIPT: R3378 $129.00
Date Paid: Monday, November 06, 2017
Paid By:AB Main Street Trust
Cashier: LE
Pay Method: CREDIT CARD 061587
/1\
Printed: Monday, November 06,2017 11:53 AM 1 o:1 n
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