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 Holder Signature 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 Residential Number 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