Permit SDC 478 W 9th St 2012 °raj ! i lij:i .
✓vY
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J "? ' - = ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
4 On S%
Application Number 12- 00000043 Date 1/11/12
Property Address 478 W 9TH ST
Application type description SYSTEM DEVELOPMENT CHARGE RESIDENTIAL (S
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
SD SEPTIC TO SEWER
Owner Contractor
BRUNER MERCEDES A ET AL OWNER
478 W 9TH ST
ATLANTIC BEACH FL 32233
Permit ADV PMT -SEWER IMPACT FEE
Additional desc . SYSTEM DEVELOPMENT CHARGE
Permit Fee . . . .00 Plan Check Fee . . .00
Issue Date . . . 1/11/12 Valuation . . . . 0
Expiration Date . 1/11/12
Other Fees SEWER SDC- SYSTEM DEV CHG 4050.00
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.
REORDER 905 • U.S. PATENT NO 5538290, 5575508, 5641183, 5785353, 5984364, 603000C
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233 -4445
4b1
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH FL 32233
ern OF ATLANTIC BEACH
800 SEMINOLE ROAD NO. 103505
ATLANTIC BEACH, FLORIDA 32233 -4445
I NVOICE INVOICE PURCHASE PROJECT ACCOUNT AM tuNT
NUMBER DATE ORDER NO. Nt7MBEd MUMMER
170935 -0000 01/05/2012 110 - 5506 - 535.83 -00 4,050.00
GROSS RETAINAGE DISCOUNT NET
$ * * * ** *4,050.00 $ * * * ** *4,050.00
J' i ce.- `_ p)
J
s <40;1 1r NEW WATER/SEWER TAP REQUEST
Date: 10/28/11 Project Address: 478 W. 9 St.
No. of Units: 1 Commercial
Residential x Multi- Family
New Water Tap( s ) & Meter(s) Meter Size(s)
to (size)
New Irrigation Meter_. Upgrade Existing Meter from_______ ----
New Connection to City Sewer 1
Name: Mercedes A. Brunner
Applicant Address: 478 W. 9 St. 32233
City:
Atlantic Beach State: FLZip:
Phone Number: (9041349 -5197 (Diane Daglevl Cell Number:
Email Address
Signature: (Applicant)
CITY STAFF USE ONLY
Application#
Sewer SDC fee to connect to City sewer,
Water System Development Charge $ and cost of plumber for CDBG grant.
Sewer System Development Charge $_ 4 050.00
Water Meter Only
Water Meter Tap b
Sewer Tap $
Cross Connection $
Other (Advantage Plumbing) $ 11 97—
TOTAL $ 66 02_
APPROVED: 40
iL.`. 0 - 2 ( //
(Utility Director or Author;y. Signature)
ALL TAP REQUE ST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE
FEES CANBEASSESSED