905 ASSISI LN n-, ryl o Q3 a, )10 ck en
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ATLANTIC BEACH
N' PERMIT RECEIPT
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PERMIT DESCRIPTION: ANTHEM LAKES ASSISTED LIVING
PERMIT NUMBER: 14-CNEW-654
ADDRESS: 905 ASSISI LN
OWNER:
FEES DUE:
UTIL REV COMMERCIAL BLDG $0.00
SEWER SDC-SYSTEM DEV CHG $67,514.00
WATER CROSS CONNECTION $200.00
WATER SDC-SYSTEM DEV CHG $19,004.00
Totals:
$86,718.00
CITY OF ATLANTIC BEACH
PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH, FL 32233
r 9'' (904) 270-2535 or (904) 247-5874
NEW WATER/SEWER TAP REQUEST
Date: 12/30/14 Project Address: 905 Assisi Lane (Anthem Lakes-Assisted Living)
No. of Units: 137 (master metered) Commercial X Residential Multi-Family
New Water Tap(s) & Meter(s)__L Meter Size(s) 4-inch
New Irrigation Meter Upgrade Existing Meter from to (size)
New Connection to City Sewer 1
Name: JBC Plannin Perry-McCall Construction
Applicant Address:
City: State: FL Zip:
Phone Number: 398-9900 ext. 2208 Cell Number:
Email Address Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application# 14-CNEW-654
New assisted living&memory care
Water System Development Charge $_19,004 center. Will be master-metered.
Sewer System Development Charge $__67_,514
Water Meter Only $ Their contractor to provide & install
Water Meter Tap $ tap &meter and sewer tap.
Sewer Tap $
Cross Connection $ 200
Other $
TOTAL $ 86,718
APPROVED: Donna Kaluzniak 1/22/15
(Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED