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�II�LI�a�G P�F�IIIEI'E' f���➢i�{�I�'Ti�N <br /> , - <br /> , nr � <br /> (1) BUILDING PER IT , <br /> - ) <br /> A�oREss , �. . t 1 1 ��� � � � .l� LY. <br /> -�—= -- ----- - — - -- <br /> - �fc��,�� l � <br /> �� � FEE � ---'�`---- <br /> y (A) PLAN CHECK FEE �� <br /> O 7q --- ��/� - —___ <br /> Ca y y (2) PLUMBING ---�G-��- - <br /> y � H (3) MECHANICAL --- <br /> �r�� �..�-, <br /> �e o (4) STATE SURCHARGES - - <br /> H � ` <br /> /- ' I— <br /> ,.��H ,.�� (h) BUILDING CODE <br /> H�N� (B) �NERGY CODE ---r1�-r -- <br /> h d (5) DRIVEWAY PERMI"i ---- <br /> ��"�� <br /> z'� <br /> O H � _. _��� �_ <br /> �M� <br /> 4:�r Q <br /> C" y� . --_ ^1�'(��' <br /> (o") WATER SERVIC�TO BE PAID PHIOR TO BUILDING PERtvJ�T ISSUANCE $ _ <<L..'-- -___ <br /> g y y (A) TO BE DETFRMINED BY BLDG. W�PECTOR '_���y_ INCH <br /> �d v' (B) EXIST. WATER SERVICE. APPtICATION NO.___ _ —._ _ <br /> ��� (7) STATUS OF SEWER CHARGES: <br /> y�� 80ND �-��- DISTRICT FOOTAGE_____ _ <br /> . . . N. S, G __W <br /> ORDINANCE 1171•85 <br /> W4TER --�i ��� — � <br /> SEWER _— "I� <br /> TCITAL ORD. FEE �v� �� <br /> I ��"'. SEWER CONNECTION CHARGES — <br /> � YEAR TRUNK $ — ����� <br /> j (��� LATERAL — —' <br /> �� � <br /> TOTAL CONNECTION CHAHGES $ ���1� <br /> '+o -� C O <br /> I ��� SEWER PERMIT FEE S �~'�' — <br /> `et I <br /> �'ri <br /> I <br /> I ' <br /> �_L <br />