Permit SDC 1455 Begonia 2011 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
App o Number . . . . . 11-00000504 Date 10/26/11
;;a g S 1 1 CC QVf1nTJT'A QIP
RE number 171082-0000- -
NCR OLD ACCOUNT NUMBERS . . . AB12485
Application type description SYSTEM DEVELOPMENT CHARGE RESIDENTIAL (S
Subdivision Name . . . . . .
Property Use . . . . . . . .
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
Owner Contractor
------------------------ ------------------------
HUMPHREY ROY E OWNER
1455 BEGONIA STREET
ATLANTIC BEACH FL 32233
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Permit . . . . . . UTIL REV FEE RESIDENTIAL BLDG
Additional desc . .
Permit Fee . . . . . 00 Plan Check Fee . 00
Issue Date . . . . 10/26/11 Valuation . . . . 0
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Other Fees . . . . . . . . . SEWER SDC-SYSTEM DEV CHG 4050 . 00
WATER CONNECT/METER ONLY 185 . 00
WATER CROSS CONNECTION 50 . 00
WATER SDC-SYSTEM DEV CHG 1140 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total . 00 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 5425 . 00 5425 . 00 . 00 . 00
Grand Total 5425 . 00 5425 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH
PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH,FL 32233
9jiM (904)270-2535 or(904)247-5874
NEW WATER/SEWER TAP REQUEST J
Date: 10/11/2011 Project Address: 1455 Bego n*ia Street
No. of Units: I Commercial Residential XXX Multi-Family
New Water Tap(s),&Meter(s), Meter Size(s)
New Irrigation Meter Upgrade Existing Meter fi-om to (size)
New Connection to City Sewer XXX
Name: Roy E. Humphrey
Applicant Address: 1455 Begonia Street
City: Atlantic Beach State: FL Zip: 32233
Phone Number: 904 861-5878 Cell Number: Same
Email Address Fax:
Signature: Submitted by David E. Thompson
(,4pplicani)
CITY STAFF USE ONLY
Application#
Water System Development Charge /!�/O CLr).R& X0 J;�41-
Sewer System Development Charge $ a.ST
Water Meter Only 4-7
Water Meter Tap $
Sewer Tap
Cross Connection
Other - Ch r C/11 $ &
070 (notes)
TOTAL
APPROVED:
--I�L(U�WiDi�,, o,o,Aut �LedSig�wtu,�V��
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CANBEASSESSED
!?,<-3&-7-
REORDER905-U-S PATFNTN0,5518290,715-755N
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH.FLORIDA 32233-4445
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH FL 32233
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD NO. 102M3
A:rLAN'FIC BEACH.FLORIDA 32233-4445
COUNT.
,INVOICE , INVOICE . ... ...
AMOUNT
Wit.,
NItMOUR DATIR..
..... ......
RE# 171082-0000 10/20/2011 110-5506-535.83-00 5,425.00
GROSS RETAINAGE DISCOUNT NET
$******5, 425 . 00 $******5,425.00
City of Atlantit. Bmil
*" ONAWER K.0-:19f X4*
Otter: MH FY lype: ft: Drawer; I
Date: 14/2-6/11 06 Receiot no; :YW
Dest-ription Qualstity Aboullt
P-01 1 %4
BP BUILDIND RRHIIIS
Lm VW�j.06
Tender detai I
EX MIX WtW $Wj.w
fetal tendered to
Total payment Kiwi.N
Trans date: IO/P6/11 fise: 13:61:15