195 15th St SEWER FEES j rS�Jr�3
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ATLANTIC BEACH
PERMIT RECEIPT
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DATE: 10/21/2014
PERMIT DESCRIPTION: NEW SINGLE FAMILY HOME (PREVIOUSLY 14-1448)
PERMIT NUMBER: 14-SFR-161
ADDRESS: 195 15TH ST
OWNER:
FEES DUE:
BUILDING PERMIT FEE $1,080.00
STATE DCA SURCHARGE $16.20
PLAN CHECK FEES $540.00
STATE DBPR SURCHARGE $16.20
UTIL REV RESIDENTIAL BLDG $50.00
SEWER SDC-SYSTEM DEV CHG $4,050.00
WATER CONNECT/TAP &METER $800.00
WATER CROSS CONNECTION $50.00
WATER SDC-SYSTEM DEV CHG $1,140.00
SEWER TAP FEES $2,900.00
Totals: $10,642.40
1
CITY OF ATLANTIC BEACH
tS1
PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH, FL 32233
r�w119r (904) 270-2535 or(904) 247-5874
NEW WATER/SEWER TAP REQUEST
Date: 9/8/14 Project Address: 195 15th St.
No. of Units: 1 Commercial Residential X Multi-Family
New Water Tap(s) & Meter(s) 1 Meter Size(s) 3/4"
New Irrigation Meter Upgrade Existing Meter from to (size)
New Connection to City Sewer 1
Name: Ossi Dev.
Applicant Address:
City: State: _FL Zip:
Phone Number: Cell Number:
Email Address Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application# 14-1448
Water System Development Charge $_1,140
Sewer System Development Charge $_4,050
Water Meter Only $
Water Meter Tap $ 800
Sewer Tap $ 2,900
Cross Connection $ 50
Other $
(notes)
TOTAL $ 8,940
APPROVED: Donna Kaluzniak 9/8/14
(Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED