2359 SEMINOLE ROAD WATER TAP �� . ' Vis\ CITY OF ATLANTIC BEACH
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!!► J 800 SEMINOLE ROAD
, ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-1513
Job Type: PLUMBING ONLY
Description: WATER METER AND CROSS CONNECT
Estimated Value:
Issue Date: 7/5/2016
Expiration Date: 1/1/2017
PROPERTY ADDRESS:
Address: 2359 SEMINOLE RD
RE Number: 168349-0000
PROPERTY OWNER:
Name: JACOBSON, SAMUEL S
Address: 2359 SEMINOLE RD
FEES:
WATER CONNECT/TAP & METER $0.00
WATER CROSS CONNECTION $0.00
Total Payments: $235.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WI III ALI. CITY OF ATLANTIC BEACH ORDINANCES AND TIIE FLORIDA
BUILDING CODES.
N � , CITY OF ATLANTIC BEACH
�� s PUBLIC UTILITIES
J,` _ . 7 1200 Sandpiper Lane
ATLANTIC BEACH, FL 32233
'+-JJ3lt (904) 270-2535 or (904) 247-5874
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NEW WATER/SEWER TAP REQUEST _ •PL`3C -1513
Date: l((/3 o Project Address: 2-357 •S 1,./6 LF. R.D.
No. of Units: I Commercial Residential +/ Multi-Family
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New Water Tap(s) & Meter(s) 1 t Meter Size(s) 3 `f
New Irrigation Meter Upgrade Existing Meter from to (size)
New Connection to City Sewer
Name: 17.40# 1;4 Co a s9N
Applicant Addre ,235-1 $ rA/9U. KD
City: kr-Ar1` Lc p_at t4, State: .Ft, Zip: 3 2.23
Phone Number: '701 -2'/0"‘/C9 Cell Number: 'loty goy-5.2ii5-
Email Address Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application#
Water System Development Charge $
Se(^)E1 FtEs Pita
0 Sewer System Development Charge $ (Al 2 00 57
Water Meter Only $ t 5: o' � 'Tv
Meter Tap $ N'DT Cow��7
Sewer Tap $ W011-€4(2- Sys
Cross Connection $ 570_ o o
Other $
TOTAL $
2-3 QO (notes)
APPROVED: 1/i 1-..------
Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED
it 0 r1 1/t/ u- To M.�T�(LSewc(2- Je.L.