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-`. �+ + <br /> BUILDING PERMIT INFORMATION � <br /> ��� <br /> Hy� <br /> C f-� , I <br /> �,y v' ADORESS -- - _ <br /> -- --- --- - - --- -- --- - - <br /> ��� (t) BUILDING PERMIT FEE � - - <br /> '�� (A) PLAN CHECK FEE --- - <br /> y y� (2) PLUMBING -- - - ', <br /> x (3� MECHANICAL <br /> p��� (4) STATE SURCHARGES ----- <br /> �� n (A) BUILDING CODE <br /> a y� (B) ENERGY CODE �--- - - <br /> t' (5) DRIVEWAY PERMIT <br /> Oh y H S -�-===2�G----__._... .,_:_ <br /> �C]�N - <br /> � y (6) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERNIT ISSUANCE 5 _._-- ����."- <br />' (A) TO BE DETERMINED BY BLDG. INSPECTOR _ _ � INCH <br /> (B) EXIST.—_____ WATER SERVICE APPLICATION NO. <br /> �:` (7) STATUS OF SEWER CHARGES: <br /> � <br /> :t �; <br /> ' BOND...__�_— DISTRICT_.. ._ _ _ .__- FOOTAGE <br /> . ._. � N. fl E. W <br /> ORDINANCE 11�1-85 <br /> WATER ,�� L � c, - <br /> SEWER � �8 no <br /> TOTAL ORD. F�E `�Y �, �o __.-_ <br /> � � _ <br /> ��' SEWER CONNECTtON CHAHGES <br /> '�1 YEAR �y TRUNK S _ _ _ -- - -_ <br /> '_' LATERAL ,.-' - ---__ _ .--- <br /> TOTAy.G6NNECTION CHARGES $ -_ ___ _ ___ -_-_-_ _ — <br /> - <br /> � 1 j <br /> 1�' r�- <br /> SEWER PERMIT FEE S - ---.5 � -- - - - <br /> �' <br /> � <br /> �' <br /> �� <br /> �' <br /> � <br /> �� <br /> 1 } <br /> ,� �.7`'`�' <br /> t + ' . <br />