701 Jasmine St Sewer CITY OF ATLANTIC BEACH
SS1
' - s PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH,FL 32233
��JFil�r (904)270-2535 or(904) 247-5874
NEW WATER/SEWER TAP REQUEST
Date: -/Z/3 Project Address: 70 � �7-rhSm/PL/67- ST-
No. of Units: Commercial Residential V Multi-Family
New Water Tap(s) & Meter(s) l Meter Size(s) ` I
New Irrigation Meter Upgrade Existing Meter from to (size)
New Connection to City Sewer ✓
Name:
Applicant Address:
City: Atlantic Beach State: Zip:
Phone Number: Cell Number:
Email Address Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application# /J—Z 93
Water System Development Charge $1, 11/0. 00
Sewer System Development Charge $ tI av
Water Meter Only $ 16)5-. 06
Water Meter Tap $ (notes)
Sewer Tap $
Cross Connection $ 1!F0. co
Other $
TOTAL $S ZS 00
APPROVED:
(Utility Dilector or thorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00001207 Date 6/10/13
Property Address . . . . . . 701 JASMINE ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
------------------------------------------------------------------------
Application desc
water sewer tap SDCR NEW HOUSE
----------------------------------------------------------------------
Owner Contractor
-
------------------------
-----------------------
CURRY, LESLEE K. OWNER
12485 AIRPORT ROAD
BILOXI MS 39532
----------------------------------------------------------------
Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . 00 Plan Check Fee . 00
Issue Date . . . . 5/13/13 Valuation . . . . 0
Expiration Date . . 11/09/13
-------------------------------------------------------------
Other Fees . . . . . . . . . SEWER SDC-SYSTEM DEV CHG 4050 . 00
WATER CONNECT/TAP & METER 800 . 00
WATER CROSS CONNECTION 50 . 00
WATER SDC-SYSTEM DEV CHG 1140 . 00
--------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total . 00 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 6040 . 00 6040 . 00 . 00 . 00
Grand Total 6040 . 00 6040 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.