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Phone NoFill in fee simple Title Holder on next page if f,
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` rt Pierce Utilities Authority
,;/'Committed To .Quality" J i
Water/Wastewater Engineering
206 South 6th Street
Ft. Pierce, FL 34950 Phone(772)466-1600
Fax (772)461-1938
6S.TOMM INVOICE {ESTIMATE ONLY)' '
QUOTE FOR SANDRA DEWSON ; � k
JOB DESCRIPTION:INSTALL NEW 5/8 x 3!4 WATER MTR PLUS SVC NO SEWER = '
INVOICE NO: SORD00003293595 PREPARED BY:WARE
LOCATION ID: 10007244
ADDRESS: 1203ROYAL PALM BL FORT PIERCE FL USA 34982=6
ADDITIONAL INFO:
STA ICS r DESCRIPTION
�. COUNT..a �.1�. _ _._ UNITirCOST _ CHARGES
W-3/4 WSVC U/G WATER 3/4 METER/SERVICE U/G $800.00 $800.00
W-CAP IM CHG WATER CAPITAL IMPROVE CHARGE $0.01 $920.50
W-CON FEE NEW WATER CONNECT FEE NEW CUST $0.01 $40.00
W-FEES PAID WATER FEES PAID $0.00 __$0.06
-TOTAL CHARGE _ ' $1,760.5C
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Customers will be assessed wastewater charges the day they connect to the wastewater system or within 365 days from date wastewater
Connection Charge is paid - whichever is first. The cost of the service line from the point of delivery at the property line to the
house/building is the responsibility,of the customer and is not included in this invoice. State laws require that a permit from the Health
Department must be obtained prior to initiating-a septic tank abandonment.Contact the Health Department at (772)873-4931.
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Construction cost estimates are based on current labor, equipment and material prices. Actual costs of construction will be determined at
the completion of the project. Should unforeseen circumstances be encountered during construction, including but not limited to adverse
weather conditions and construction conflicts, the customer will be responsible for increased costs. Additional costs incurred by the
customer shall not exceed fifteen (15) percent of the total estimated construction costs shown above. Estimated costs paid by the
customer that exceed the actual cost.of construction will be refunded by Fort Pierce Utilities Authority.All fees are due prior to any
construction.
Note: This is only an estimate. A bill will be provided following acceptance of the Customer Invoice once signed and_dated., .Please._,
submit accepted Customer Invoice to Customer Service at 206 South.6th.Street,.-Ft.-Pierce;-FL' 34950 or calf(772)466=1600 to setup an...;%
Cusfomer Signature: Date:
Printed Name:
PAGE 1 OF 1 PRINTED ON: 06/30/2017 AT 10:07 AP
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982,
(772)462-1553 Fax(772)462-1578
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PERMIT RENEWAL REQUEST
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;
PERMIT NUMBER: llO�q ' ADDRESS: D C ` 1 /`
r
I, l/l / / �.eel/ ,am requesting,that the above,permit be renewed. I
unde—r—sfand that I must schedule and pass all required Inspections for the permit to be finaled. Further, I
understand that this is,a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
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QDX1fWb
LDR OR C TOR ATURE PATE 'I
rint Name
II ,
STATE OF FLORIDA.
COUNTY OF 7�k �
ACKNOWLEDGED B FORE METHIS QDAY OF 20�_
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BY%N'X pO-D � WHO IS PERSONALLY KNOWN TO ME . OR
HAS PROVIDED ' ��^ 3��'o AS IDENTIFICATION. `
ATE OF FLORIDA,County of i�-AgHAHN state of Flctida ti
pub
jyptafy m EXP�f es Dec 7720.918 ,
Dommission#FF,1 pssn.�r
G ATURE OF NOT YCom h{latienal NotacY
.�4 o�c onded thtou9
i T -F�, PJ
,pF O�„p
____________________________________________________ _________________________________�_______ _ ----__________-__________________,
FOR OFFICE USE ONLY: JL ®� 0p
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee) a
Revised 7/21/2014
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