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� <br />� , <br /> I <br />�4 F3llIL.�lNG PERMIT INF�RMATION <br /> I <br /> �e �� <br /> ADDRESS �����hor LkIL�C � <br /> (1) BUILDINGPERMITFEE � �5 �•Qd <br /> y�� (A) PLANCHECKFEE (fl;�.v1->U` - 57'�• Q3 � � '�� • , <br /> [79H (2) PLUMBING 9r-��— <br /> C�H (3) MECHANICAL $��`�' �— <br /> ta+ ay (4) STATE SURCHARGES — <br /> � z� (A) BUILDING CODE � - S O <br /> a Ho (B) ENERGYCODE r r•G� <br /> y�"' (5) DRIVEWAYPERMIT Z� '��� <br /> �1 �� 5 --�--���Z? <br /> �d <br /> H �g � � oL <br /> c'�� c� (6) WATER SERVI�E TO BE PAID PRIOR TO BUILDING PERM11IT ISSUANCE S _ <br /> a y�y (A) TO BE DETERMINED BY BLDG. INSPECTOR ._ _ __'Ly �� __ INCH <br /> r y H (B) EXIST. _ WATER SERVICE APPLICATION NO._ <br /> gry y (7) STATUS OF SEWER CHARGES: <br /> � [�� BOND_._ _ —_ DISTRICT _ ___ FOOTAGE N, s, E w <br /> Z H Cn <br /> HOtn <br /> T�1 i � � 0'F i S ORDINANCE 1171•85 ��Ll pG <br /> WATER <br /> �� �L�� # � SE'NER wntil <br /> TOTAL ORD. FEE ��`� d� <br /> ++s <br /> v� , <br /> SEWER CONNcCTION CHARGES <br /> ���� �. �y� }- S 35 -�rt_�� YEAR ______ TRUNK S <br /> LATERAL <br /> �......i TOTAL CONNECTION CHARGES S <br /> �— -�-- <br /> SEWER PERMIT FEE 5 ✓ Q� <br /> ��� <br /> �— — <br /> es���w�l � 6��1 c,� ; <br /> _! <br /> �,d'1,'�'.�� u���',,,,kcc� <br /> �'USPNt� <br /> _` 3� 55 � � I, l�s � � � <br /> u � 9 ,s <br /> _--- --- <br /> ��i5, � �� � c �as �a, �.za� <br /> ����� � n � �' �a 'i 1 �� l <br /> — <br />