2630 STATE ROAD A1A WATER METER PERMIT �J `S, CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
JX ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
COMMERICAL ALTERATION/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-COTH-1448
Job Type: COMMERCIAL OTHER
Description: TWO NEW WATER METERS - IN JACKSONVILLE
Estimated Value:
Issue Date: 6/23/2016
Expiration Date: 12/20/2016
PROPERTY ADDRESS:
Address: 2630 STATE ROAD A1A
RE Number: None
PERMIT INFORMATION:
FEES:
WATER CONNECT/TAP & METER $370.00
WATER CROSS CONNECTION $100.00
Total Payments: $470.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Yrl
CITY OF ATLANTIC BEACH
Ss�
PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH FL 32233
~!J'3l>r (904) 270-2535 or(904) 247-5874
NEW WATER/SEWER TAP REQUEST ` C444Z�2 �l
Date: & Project Address: 2(0 30 S a,OAQ 14'114
No. of Units: 2— Commercial V Residential Multi-Family
New Water Tap(s) &Meter(s) Meter Size(s) `31,q
New Irrigation Meter Upgrade Existing Meter from to (size)
New Reclaim Water Meter Size New Connection to City Sewer
l
Name:
Applicant Address: 2-6, 'L �, �c "12-7 _3 ZZ 3 3
City: State: Zip
Phone Number: - Y4-? --4�9xell Number: Z -ff
Email Address - Wiz/c�! 6� r6T Fax:
Signature: /46-4 y
( pplicant
CITY STAFF USE ONLY
Application#
Water System Development Charge $ -0'
Sewer System Development Charge $ &—
Water Meter Only $ 3 70 , 00
Reclaim Meter Only $
Water Meter Tap $ (notes)
Sewer Tap $
Cross Connection $ 100, 00
Other $
TOTAL $ • C5Z)
APPROVED: Kayle Moore, PE
(Deputy PW Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED