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FOR OFFICE IjSC ONLY
<br /> ADDRESS
<br /> (1) BUILDINGPERMITFEE $
<br /> (A) PLAN CHECK FEE
<br /> (2) PLUMBING
<br /> (3) MECHANICAL � ,-������c��; S 7��, ,
<br /> (4) STATE SURCHARGES "'' • -- � S
<br /> ;;,h�.:
<br /> �
<br /> (A) BUILDING CODE --' �;,;� -
<br /> (B) ENERGY CODE , —
<br /> (5) DRIVEWAY PERMIT "� t
<br /> z.I ':',
<br /> '�""'_.
<br /> $
<br /> ("o) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE $
<br /> (A) TO BE DETERMINED BY BLDG. INSPECTOR INCH
<br /> (0) EXIST. WATER SERVICE.A.�PLICATION NO.
<br /> I (7) STATUS OF SEWER CHARGES:
<br /> 80ND DISTRICT FOOTAGE
<br /> N, 5, E,W
<br /> SYSTEMS DEVELOPMENT
<br /> WATER
<br /> SEWER
<br /> TOTAL ORD. FEE
<br /> SEWER CONNECTION CHARGES
<br /> YEAR TRUNK g
<br /> LATERAL
<br /> TOTAL CONNEGTION CHARGES $
<br /> SEWER PERMIT FEE g
<br /> ;,..,�.
<br /> i -
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