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, ,.. <br /> 4 <br /> � vncr:�1 <br /> BUILDING PERM11' �NFORAl1AT10N <br /> ��� ' <br /> Q � <br /> 9 y ADDRESS. ——---- ---- — - � _ <br /> y��c �1) BUILDIN ERMIT FEE $ _— <br /> 'd � (A) PLAN CH CK FEE <br /> 'V�� (2) PLUMBING � _ _ <br /> �z (3) MECHANICAL <br /> �� (4) S7ATE SURCHARGES _ <br /> ,�,i�g (A) BUILDING CODE \ <br /> �� � (B) ENERGY CODE -- <br /> yH <br /> �,y (5) DRIVFWAY PEFN17 <br /> r y r.i / $ ---_ <br /> � V � <br /> ��`° � _ __-__ <br /> y� (6) WATER SERVICE TO BE PAID PRIOR TO BU�ING PERMIT ISSUANC/E� $ --- <br /> � (A) TO BE UETERMINED BY BLDG. INSPECTO�}_--_— INCH <br /> (B) EXIST. —WATER SERVICE APPUCATI�'�N NO.__�----- <br /> . <br /> (7) STATUS OF SEWER CHARGES: ' , <br /> BOND--- -_..-- --- DIS'RICT _ FOOTAGE _ _ .— <br /> N, S, W <br /> ORDINANCE 1171-85 <br /> WATER -- <br /> SEVt`cR — <br /> TOTAL ORD. F .E -� ___--_---- <br /> ��\I `\ <br /> � SEWER CONN G1''ON CHARGES <br /> t <br /> I �� YEAR --- - — — TRUNK $ -- --- ------ <br /> LATEFiAL — <br /> I TOTAL CO NECTION CHAFGES $ ___ _ <br /> I �� SEW PERMITFFE $ <br /> � <br /> l�,1�1 <br /> � ��� <br /> �I <br /> 1�1� <br />