Building Permit Number:

City of Green Cove Springs Plumbing Permit Application

Owner / Contractor Information

Owner: Phone:

Address:

Contractor: Phone:

Address:

Property Address/ Parcel #

Characteristics of Proposed Plumbing Work

Signature of License HolderSignature of Owner

I hereby certify that I have read and examined this permit and know the same to be complete and correct. All provisions of laws and ordinances governing this type of work will be completed with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other State or Local law regulating construction or the performance of construction.

Permit issuance does not relieve you from the responsibility of obtaining permits from any Federal, State, and / or local agencies asserting concurrent jurisdiction for this work.

Additional Information

A. Use of Building

Residential

Single Family

Multi-Family

Units:

Transient, Hotel, Motel, Rooming House

Units:

Mobile Home

Other Residential

Non-Residential

Amusement, Recreation

Religious Institution

Industrial

Garage Service Station

Professional Office, Bank

Educational, Libary

Store, Merchantile

Other

B. Ownership

Private

Public

C. Nature of Work

New Building

Addition or Alter

D. GCS Approval

By:

Date:

Fee Information

ResidentialNumber of Bathrooms

Additions or Alterations

No, fixtures requiring water and or

Waste Outlets

Minimum Fee

Permit Fee Commercial

Sprinkler Heads

For each additional fixture having water supply and or waste outlet including floor and roof drains

Number of Fixtures

Minimum Fee

Permit Fee

Additions /Alterations charges same as new Con