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� UU1LLl:�IJ t�:>D..�ill 1:�3' Vi�..-'- - -�-•�_ <br /> :;�DZEss �>�� f���'' ,�r;��' — <br /> � � ��. D,^.T F,� - ��� `I- 7J i <br /> rY�'? CF BUILDING � ' �S <br /> : ; i L"iLD?:.� PER�;IT FEE i I���¢� �L $�—� I <br /> � Qi%,v�—I <br /> IA) PLAN CHEC?i FEE <br /> _ :T�R SER�'?C'r'. I O BE PAID BEFOP.E BLTILD?:�G ��y�I 0 N��-� �I <br /> ?i:R:�:1T IS ISSuED ' <br /> iA) TC BE DF"' LP,\SL�r.D BY PLEG. II1'SP. _______ I\CH <br /> N - <br /> IB) E-':TST. J_'�(�' �I�• \'�ATER. SER\'ICE. APP1.. �O. 7l L <br /> iCl LCCATIG:: , " � ' '�/� � �� <br /> C I-I_4 P.T -S ' �-%! <br /> JPI1'=.�'�AY PER�l?? TO EE PAiD Iii-FCkE �liILD?:<G NO,U �, <br /> PER\'iT IS ISS'JED FT. _ n `:'� (TI pF) S <br /> rx�_ �Alzr��c� IN � �.�..� Y TCT^,�_ = /:37. � <br /> - `� STAT:'S Cr SE1':LR Cii9RGE5: <br /> £C::1 il.�, • cII�5TRICT FOOTAGE :\. S. E, :':. <br /> _ . ��' :. - _.:C"i� ISE�';ER GO\:��CTiC:� CI�yF.G�:�: � -- <br /> TRli\f: � <br /> i i:Tt.RAL 5 '�' — <br /> _�- <br /> � TCTAL CCti\�CT:C` GKyRGE `_ _ <br /> SEti�'ER PEP,`�4IT FEE <br /> S JO . �� �� <br /> �CATCH BASL� PER�?I7' r EE 5 - <br /> TOTAL SEtS'ER PERh4IT FEES S � �'� � <br /> ; i '..�`\T;__`' ci.t';r}+ C'ri'_�GES: <br /> r . <br /> �i;'�';'�i< C i;::�T P.l C T i O':: ��� <br /> TRUNK 5, <br /> i.�TEFAL S �r <br /> SE\ti'E:; SE:c\'IGE: $ �SO <br /> � CCATIC` OF' SiDE SE�VER OR TEE L'Q TH� MAI\: CH.4P,TL:3O-Z � / � ��� N, .�r.. <br /> S_G�_5"���� _'C'�R�21�����ZCC--'�—�—�=7— 71, <br /> i � � <br /> :�, ('�L � S/ E . DF CtJjZ('S_ APP�.OK 4 E E <br /> .� DATE 7/ %'� <br /> i^:FO CO\SPILED BY: �O/ � <br /> �/'k'_ /, -- __ . __ _ _ DATE ��' •1:�:; <br /> EEV'IEW: ��f '� ' � <br /> TR�IC DI\ i5 OIv <br /> /� � DA T E -'��� /'�_ <br /> APPROVAL�'.-_�" � • - - <br /> �:� . . � <br /> 'GI1�E RING D£PAR tE.`�i <br /> This total must be paid beior�• builcir.c p�T�»'t �= �"�ire. <br />