Permit 480 W 9th St 2011 Sewer Fee . .. r
1� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 11-00003055 Date 12/29/11
Property Address . . . . . . 480 W 9TH ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
SEWER DEVELPOMENT FEE
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Owner Contractor
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SHIRLEY TAYLOR OWNER
480 9TH STREET WEST
ATLANTIC BEACH FL 32233
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . . 00 Plan Check Fee . 00
Issue Date . . . . 12/29/11 Valuation . . . . 0
Expiration Date . . 6/27/12
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Other Fees . . . . . . . . . SEWER SDC-SYSTEM DEV CHG 4050 . 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 4050 . 00 4050 . 00 . 00 . 00
Grand Total 4050 . 00 4050 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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CITY OF ATLANTIC BEACH
PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH,FL 32233
(904) 270-2535 or(904) 247-5874
NEW WATER/SEWER TAP REQUEST
Date: 11/18/11 Project Address: 480 W. 9th St.
No. of Units: 1 Commercial Residential X Multi-Family
New Water Tap(s) &Meter(s) Meter Sizes)
New Irrigation Meter Upgrade Existing Meter from to (size)
New Connection to City Sewer 1
Name: ShirleyTa for
Applicant Address: 480 W. 9th St.
City: Atlantic Beach State: FL Zip 32233
Phone Number: 904-241-8691 Cell Number:
Email Address Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application#
Water System Development Charge $ SDC for sewer connection.
Sewer System Development Charge $_4.,050.00
Water Meter Only $
Water Meter Tap $
Sewer Tap $
Cross Connection $
Other $
(notes)
TOTAL $ 4,050.00
APPROVED: Donna Kaluzniak
(Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED
CHECK REQUEST
DATE 12/28/11
VENDOR NO. 2948 J
PAYEE City of Atlantic Beach JJfI-�
ADDRESS 800 Seminole Road
CITY Atlantic Beach
STATE FL
ZIP CODE 32233
ACCOUNT DESCRIPTION ACCOUNT NUMBER PROJECT NO. AMOUNT
Sewer Other Contractual Services 410-5506-535.34-07 $4,050.00
Subtotal from Page 2
TOTAL $4,050.00
DESCRIPTION OF ITEM OR SERVICE:
Sewer impact fee for 480 W. 9th St. RE No. 170970-0000
SPECIAL INSTRUCTIONS:
Please forward check to the Building Department for processing
To expedite processing,please attach adequate documentation to support payment.
ADDITIONAL APPROVALS ONLY REQUIRED
WHEN CHECK REQUEST IS OVER$500
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REQUESTED BY/DATE DEPT HEAD/DATE FINANCE DIR/DATE CITY MGR/DATE
O:\Utility\SEPTIC TO SEWER CONVERSIONS\[480 W 9th fee check request.xlsx]Form Pg. 1