174 15th St PLRS20-0053 21 Fixtures Y
S "'l� PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
" " 5 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD PLRS20-0053
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ISSUED: 3/16/2020
,� EXPIRES: 9/12/2020
ATLANTIC BEACH. FL 32233
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
174 15TH ST PLUMBING RESIDENTIAL PLUMBING - 21 FIXTURES $6000.00
TYPE OF REAL ESTATE I BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171866 0000 MANDALAY
COMPANY: ADDRESS: CITY: STATE: I ZIP:
CANNON PLUMBING, INC. 1718 EAST CHURCH STREET JACKSONVILLE FL 32202
OWNER: ADDRESS: CITY: STATE: ZIP:
MARCO MICHAEL 2399 OCEAN BREEZE CT ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 0 $0.00
PLUMBING FIXTURES 455-0000-322-1000 21 $147.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.03
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.02
TOTAL: $207.05
Issued Date: 3/16/2020 1 of 2
`,I.Apir%, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
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J `: PLRS20-0053
_ .� CITY OF ATLANTIC BEACH
.4 800 SEMINOLE ROAD ISSUED: 3/16/2020
; 'r ATLANTIC BEACH. FL 32233 EXPIRES: 9/12/2020 y
Issued Date: 3/16/2020 2 of 2
Plumbing Permit Application **ALL INFORMATIONHIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
f-*',...,
800 Seminole Rd, Atlantic Beach, FL 32233 PLRS ZO - Ob S
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS:
174 15th Street PROJECT VALUE $6.00
✓NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 2 Septic Tank& Pit
Clothes Washer 1 Shower 3
Dishwasher 1 Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 5
Hose Bibs 2 • Urinal
Kitchen Sink 1 . Vacuum Breakers
Laundry Tray - Water Connected Appliances
Lavatory 5 Water Heater 1
Other Fixtures _I , Water Treating System
DVIISCELLANEOUS
❑Sewer Replacement
❑Back Flow Preventer
El Lawn Sprinkler System (number of sprinkler heads)
❑Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑Well *'SJRWD Well Completion Form.Completed form to be submitted to the Building Department for final inspection. **
pother
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.
Owner Name: Phone Number:
Plumbing Company: CANNON PLUMBING INC Office Phone: (904)744-6350 Fax
Co. Address: 1718 E CHURCH STREET City: JACKSONVILLE State: FL Zip: 32202
License Holder: OLIN CANNON State Certification/Registration # CFC1426140
Notarized Signature of License Holder (2,A.------
0
The foregoing instrument was acknowledged before me this ICday of r' M 1C1"\ , 20&), in the State of Florida,
County of 2}u12, I
-Sti--9-ra
..0„Ry Robbie BielerSignature of Notary Pub
:,..4. ',-.....,NOTARY PUBLIC
STATE OF FLORIDA
o Personally Known OR ( ) Produced Identification
;;, ?Comm#GG158647
./N E 1910 Expires 11/7/2021 Type of Identification:
Updated 10/17/18
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JCash Register Receipt Receipt Number
City of Atlantic Beach R11995
DESCRIPTION I ACCOUNT I QTY PAID
PermitTRAK $207.05
PLRS20-0053 Address: 174 15TH ST APN: 171866 0000 $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 455-0000-208-0700 0 $3.03
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.02
TOTAL FEES PAID BY RECEIPT: R11995 $207.05
Date Paid: Monday, March 16, 2020
Paid By: CANNON PLUMBING, INC.
Cashier: FJ
Pay Method: CREDIT CARD 5
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Printed: Monday, March 16, 2020 12:46 PM 1 of 1 I