Permit SDC 1225 Hibiscus 2012 %\ CITY OF ATLANTIC BEACH
r j 800 SEMINOLE ROAD
j ' .5 ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000378 Date 5/02/12
Property Address 1225 HIBISCUS ST
Application type description SYSTEM DEVELOPMENT CHARGE RESIDENTIAL (S
Property Zoning TO BE UPDATED
Application valuation . . . 0
Owner Contractor
OSBORN STEVEN F & MONICA OWNER
1470 MARSH VIEW CT
ATLANTIC BEACH FL 32233
Permit ADV PMT -SEWER IMPACT FEE
Additional desc . SDCH SEWER
Permit Fee . . . .00 Plan Check Fee . . .00
Issue Date . . . 4/04/12 Valuation . . . . 0
Expiration Date . 4/04/12
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.
CHECK REQUEST
„
DATE 03/27/12
s -)
VENDOR NO. 2948
PAYEE City of Atlantic Beach
ADDRESS 800 Seminole Road
POSTED
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 1225 Hibiscus St. RE No 171058-0050 PA 1 D
APR 0 4 2012
SPECIAL INSTRUCTIONS: CK
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
O
ANJWIVAIF 2.-/f /71 DR / '-'17430//2
REQU TED "" / DATE DEPT HEAD / DATE FIN N DATE MG 1TY MG DATE
O:\Finance\finance forms\Check & ACH Request Forms\[sewer impact fee check request.xlsjForm Pg. 1