1619 Atlantic Beach Dr ATLANTIC BEACH
PERMIT RECEIPT
PERMIT DESCRIPTION: NEW SINGLE FAMILY RESIDENCE
PERMIT NUMBER: 16-SFR-956
ADDRESS: 1619 ATLANTIC BEACH DR
OWNER:
DATE ISSUED:
FEES DUE:
ENG REV RESIDENTIAL BLD $100.00
PLAN CHECK FEES $890.00
UTIL REV RESIDENTIAL BLDG $50.00
BUILDING PERMIT FEE $1,780.00
STATE DCA SURCHARGE $26.70
SEWER SDC-SYSTEM DEV CHG $4,050.00
STATE DBPR SURCHARGE $26.70
WATER CONNECT/TAP& METER $370.00
WATER CROSS CONNECTION $50.00
WATER SDC-SYSTEM DEV CHG $1,140.00
Totals:
$8,483.40
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1200 Sandpiper sane
ATEA r'C REACH,PL 32233
(9041)270-2535 or(9 64)247-5974
NEW WATER/SEWER/SEWER TAP REQUEST
Date: — Z S—/&I Project Address: / 9TJe4w m
No. of Units: Commercial Residential Multi-E$ ,
New Water Tap(s)&Meter(s) Meter Sizes)
New Irrigation Meter '� Upgrade Existing Meter from to (size)
New Reclaimed Water Meter V---'Size New Connection to City Sewer we,-"
Name:
Applicant Address:
City: State: Zip
Phone Number: Cell Number:
Email Address Fax:
Signature:
(milk")
CITY STAFF USE ONLY IS St2 _�S"�
Water System Development Charge $ (�, ✓
Sewer System Development Charge $
Water Meter Only $
IN
Reclaimed Meter Only $ / S. po 3,-10
Water Meter Tap $
Sewer Tap $ (notes)
Cross Connection �0 /
Other $
TOTAL o� O
APPROVED: Iavle Moore.P)E x
(Deputy PW Director or Authorized Signature) ALL TAP REQUEST MUST DE
APPROVED BY UTLI7IES DEPART MgENT BEFO E FEES C14NEEASSESSED