HomeMy WebLinkAboutUTILITY SERVICE INFORMATION2/ 0 u7-
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Port St. Lucie Utility Systems Department
Utility Service Information
Telephone: (772) 873-6400 Email: UtilEng@cityofpsi.com
Submit completed worksheet, applicable plans and fees.
1. Project Name: B u s 1 n as s N a m a: G GAA&,I,
Plaza Name:
2. Type Of Establishment: RQZW-a4a� Square Footage:
(Be Specific: i.e., Restaurant, Doctor's Office, Real Estate Office,
3. Applicant: (Owner of Business)
Name: R az�UL Title: (n&rvQ,,%_,
Company Name: TaxlD#: Li,7-�41622(_-2y
Mailing Address: S T-_ FdL!=�iAck rsT 'V:A -14 18-
E-Mail Address: RNCHT-- M G INk (7�0 P Sho t a: Zip:
T ele o In one: �SbA R �_Q o_471 I -f "4 hi, - U K, --I
4. Service Address Of Facility:
Include Bay/Suite Number
Street Address
Bay/Suite Number
, fvL
L; I ty State Zip
5. Type Of Service Requested: (Check appropriate boxes)
Water Wastewater Fire Protection Irrigation
Proposed 1-1 EJ o N/A
Existing B�_ -ER,
Fire Line Required: Yes If Yes, Indicate Line(s) And Size(s):
No
6. Water Meter Upgrade: YESE] NO (;�'
7. Interior Changes/Upgrades: YESIV(plans included and will be retained by PSLUSD)
8. Fee Included:$
FOR PSLUSD OFFICE USE ONLY
Project Narne��*Ck,\A!6 I
Fee Receipt No: V�l � a,
ERC's Reserved:— ERC's used — historical:
Effective Date:1010112013
NO []
Sub -File No.: 11.
Date:
(attach historical)
PSLUSD Doc No. 116
Utility-Service-1nformation Page 1 of 2
Utility Service Information
8. Proposed Hours Of Operation:
Monday: 113 c-) AM to )0!-3<) PM
Tuesday: 11 4 30 AM to lo.%
�3 M
Wednesday: lf3O AM to 16, �0 PM
Thursday: It Yo AM to IP 66 PM
Friday:
11 3 C) AM to
//3o
PM
Saturday:
?f 36 AM to
1/i 0
PM
Sunday:
1130 AM to
/OAD
PM
9. Flow Derivation (Select only One Category — A or B or C or D)
Check the appropriate category used to determine the ERC flows for your project.
El A. Estimated by the PSLUSD: The applicant can defer to the PSLUSD to estimate water usage.
E] B. Historical ERG Data based an current usage: See our historical flow use instructions
Section 61.11(9) of the City Code.
Calculated ERCS: (attach all historical data)
0 C. Fixture Unit Method: See the Florida Plumbing Code fixture units table for fixture units.
Total ERC Value Number of Fixture Units
20
Fixture Units_— 20 ERCs
77,
Type of Establishment Wer ERC Table.):
Applicable "Units": No. Of Beds:
Square Feet: �Koc, No. Of Seats: aL(D (including bar & outdoor seating)
Employees: Total No. � C-) Per Shift (� — (0 Shifts per Day 1�
Other:
ERC Factor: x Units = ERCs
By my signature below, I acknowledge that approval of this application may result in a
modification to the Utility Service Agreement for this property and may require property
improvements and the payment of additional fees.
J
Signa 're of plic ni (Ownor of Business) Date
/tl,e " � L
Signku.pr6,DA0vinar I Owner's Agent (owner of Property) D aTe
Page 2 of 2 PSLUSD Doc No. 116