1851 Beach Ave plbg permit j%,V j
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS18-0016
Description: RE PIPE - 9 FIXTURES
Estimated Value: 0
Issue Date: 1/18/2018
Expiration Date: 7/17/2018
PROPERTY ADDRESS:
Address: 1851 BEACH AVE
RE Number: 169723 1105
PROPERTY OWNER:
Name: JEFF YOUNG
Address: 13724 HOPE SOUND CT
JACKSONVILLE, FL 32225
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
Ph(904) 247-5826 Fax(904) 247-5845 i >L RS (cO) o o ' /
JOB ADDRESS: PERMIT# `O
NEW OR REPLACEMENT INSTALLATION: Project Value $
.TYPE of FIXTURE QTY TYPE oFFIXmu-, 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
RE-PIPE:
.TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Part
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 ❑ Well **
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
,�(Othex XCaE A
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 goveming this work will be complied with whether specified
or riot_ 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 A( 1 Mn Q Phone Numbeir(W Sssi&m
Plumbing Company CA(\t an 9kLA- "ems r nc- Office Phone (qu�lqq-(M Fax � I
Co. Address: ,h ,_ c4Lak=&k:. City 6af e State%(. Zip &Zd'2„
License.Holder(Print): State Certification/Registration# CPC I lht L 1 Y-0
.Notarized,Signature of License Holder
LESLIE DALE Sworn and subscribed before me this day of ..)afltr" 20 1 q
P m Commission#FF 144322
Expires duly 2$,20118 Signature of Not Public
me.
t� SoMThmNYOwn ma W488ao�0 � �}' � �
J _ Cash
Register
• • • • • Receipt Number
City of
• • I
DESCRIPTION • QTY PAID
PermitTRAK $122.00
PLRS18-0016 Address: 1851 BEACH AVE APN: 169723 1105 $122.00
PLUMBING $118.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 9 $63.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
'TOTALBY • • 11
Date Paid: Thursday, January 18, 2018
Paid By: CANNON PLUMBING, INC.
Cashier: CB
Pay Method: CREDIT CARD 2
Printed:Thursday,January 18, 2018 9:59 AM 1 of 1 �
TRA..T