2079 Mayport - Utility Permit CITY OF ATLANTIC BEACH
r' 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
UTILITY SERVICE -
MUST CALL BY 4PM FOR NEW DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: UTIL17-0017
Description: Outside City Limits-Permit For Utilities
Estimated Value: 0
Issue Date: 8/23/2017
Expiration Date: 2/19/2018
PROPERTY ADDRESS:
Address: 2079 MAYPORT RD
RE Number:
PROPERTY OWNER:
Name:
Address:
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name:
Address:
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
C09
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CiI7-IX7
ty of Atlantic BeachI� PUBLIC UTILITIES DEPARTMENT
ci1200 Sandpiper Lane
Atlantic Beach, FL 32233
(904)247-5834
NEW WATER /SEWER TAP REQ(IEST
?- It
p64/r b E2
Date O - l t -t -7 Project Address 20 /r7 9 M/-2) Q✓Ir /20
Numberof Units t Commercial V,/ Residential_ Multi-Family_
New Water Tap(s) & Meter(s) Meter Size(s) l - Ili,
/
New Irrigation Meter V Upgrade Existing Meter from to (size)
i
New Reclaim Water Meter_ Size New Connection to City Sewer ✓
Applicant Name
Applicant Address
City State Zip
Phone Cell
Email
Applicant Signature
CITYSTAFF USE ONLY
Application# J1rr-(-S IDS C_/ i y
-1'U r c- r oN
Water System Development Charge $ 3. 717 00 ln� n
n � C Vim' I i S
Sewer System Development Charge 513, 487 . OO Gov S�
Water Meter Only $ -6,50. 019
Reclaim Meter Only $
Water Meter Tap $
Sewer Tap $
Cross Connection $ .40. Dn
Other $
TOTAL $ ( 7, 883. 00 (Notes)
APPROVED Kayle Moore, P.E. �G4/� Date (7
Public Utilities Director or Authorized Signature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED
�f S:b�/"
Cash Register Receipt Receipt Number
fy '
City of Atlantic Beach R2361
DESCRIPTION ACCOUNTCITY PAID
PermitTRAK $17,883.00
UTIL17-0017 Address: 2079 MAYPORT RD APN: $17,883.00
PUBLIC UTILITIES $17,883.00
CROSSCONNECTION 400-ODOO-343-3701 2 $50.00
WATERSYSTEM DEVELOPMENT IMPACT 415-0000324-0301 2 $3,796.00
CHARGE
SEWERSYSTEM DEVELOPMENT CHARGE 415-0000324-0301 2 $13,487.00
WATER METER ONLY DOMESTIC 4000000343-3301 0 $550.00
TOTAL • •a
CRY OF ATLANTIC BEACH
$00 SEMINOLE RD
ATLANTIC BEAC,R.32233
08 21,2017 15:40'A$
CREDIT CARD
MC SAIF
CARD# XXXXXXXI 7264
INVOICE 0004
SEQ#: 0003
am#: 000630
Approval Code: 000433
Entry 1-e01od: Maual
Mode: aft
Tav ArrlNnt $000
Cad Code: M
SALE AMOUNT $1702
CUSTOMER COPY
Date Paid:Wednesday,August 23, 2017
Paid By: Caliber Collision
Cashier: LE
Pay Method:CREDIT CARD 4
Printed:Wednesday,August 23,20173:41 PM 1 of 1