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FOI� OFFICE USE ONLY <br />ADDRESS <br />(1) BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />(2) PLUMBING <br />(3) MECHANICAL <br />(4) STATE SURCHARGES <br />(A) BUILDING CODE <br />(B) ENERGY CODE <br />(5) DRIVEWAY PERMIT <br />(6) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE <br />(A) TO BE DETERMINED BY BLDG. INSPECTOR INCH <br />(B) EXIST. WATER SERVICE. APPLICATION NO. <br />(7) STATUS OF SEWER CHARGES: <br />BOND DISTRICT FOOTAGE <br />N, S, E, W <br />SYSTEMS DEVELOPMENT <br />WATER <br />SEWER <br />TOTAL ORD. FEE <br />SEWER CONNECTION CHARGES <br />YEAR TRUNK <br />LATERAL <br />TOTAL CONNECTION CHARGES <br />SEWER PERMIT FEE <br />$ <br />a <br />$ � " �o � <br />L/J <br />r <br />. i <br />i i <br />$ .�D <br />3 <br />$ �2 <br />$ �D <br />