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.� ,.-, <br /> BUILDII�lG PERMIT INFORMATION <br /> ��� <br /> H <br /> q' � : <br /> �� y ADDRESS - ._ - <br /> -- -- - -- - - - - - <br /> y �' � (1) BUILDING PERMIT FEE g -- --- <br /> �H� (A) PLAN CHECK FEE - - - <br /> ��y� (2) PLUMBING -- - - <br /> �xo (3) MECHANICAL - <br /> p H �4) STATE SURCHARGES - -- - <br /> �Y,q� (A) BUILDING CODE <br /> O __.— _ _. <br /> �y� (8) ENERGY CODE -- --- - <br /> �y y (5) DRIVEWAY PERMIT -- -- - - - <br /> �+ $ -=--- ��- <br /> ot,�rn <br /> �� – - - <br /> H� (6) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE 5 __ . !i�'_'�_-- -- <br /> � � (A) TO BE DETERMINED BY BLDG. INSPECTOR_ ____, � INCH <br /> (B) EXIST.________ WATER SERVICE APPLICATION NO. <br /> (7) STATUS Of SEWER CHA,RGES: <br /> BOND _ __ __._ DISTRICT . _ _ FOOTAGE <br /> N. 5, E W <br /> ORDINANCE 1171•85 <br /> WATEFi --`�U-� - <br /> SEWER __Loa'_�__ .. ---- <br /> TOTAL ORD. FEE _�`Z�9_____,___ , <br /> '�t =_----- _ <br /> ��I SEWER CONNECTION CHARGFS <br /> '�' YEAR TqUNK 5 _ ____\ <br /> 1_' LATERAL -- -.– ----- - <br /> TOTAL CONNECTION CHl1RGES 5 _ . _ —__–.__ <br /> � � <br /> ��I SEWER PERMIT FEE $ __ -_�`�- -- <br /> �1 <br /> � <br /> � � <br /> ��� <br /> �' <br /> � <br />