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` �� � <br /> ' DE►ARTMENT Of COMMUNITY DEVELO�MENT SERVICES <br /> r . <br /> BUILDING PERMIT INFORMATION <br /> ADDRE55 ���¢ ��'�"r�� �"��Y _TYPE � �'� <br /> (1) BUILDING PERMIT FEE �2i��"�� 5 `��9"�a <br /> (A) PLAN CHECK FEE � 'p � �u�' <br /> (2) PLUMBINC 2B-oD _ <br /> (3) MECHANICAL �2� �� <br /> (4) WATER SERVICE TO BE PAID PRIOR T�� BUILDING PERMIT ISSUANCE �(0 . od <br /> (A) TO BE DETERMINED Bl' BLDC INSPECTOR�INCH � <br /> (B) EXiST. _ WATER SERVICE, APPLICATION Nb� � <br /> (C) APPROX. LOCATION `�'�` Mp�� �-�"�` �'JZ �T �_ <br /> � <br /> oF�% I��ti>� W2�' -CHART J-- $ - Z���/ <br /> (5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDING PERMIT IS- �O Ov <br /> SUANCE _FEET _DRIV[.WAY(TYPEj S <br /> S <br /> (7) STATUS OF SEWER CHARGES: <br /> BOND �—DISTRICT FOOTAGE <br /> N, S, E, W <br /> NOTES <br /> e,`'�''-.,..i�1G �EZUEz G.rss1�{�5 <br /> O.F'.O p�'¢' E7�3 <br /> 5�-.'"['. �8cr�-ov � <br /> SEWER CONNECTION CHARGES <br /> YEAR �Q TRUNK 5 2�0• 00 <br /> LATERAL <br /> TOTAL CONNECTION CHARGES 3 L T� � <br /> SEWER PERMIT FEE 3 .30�OZ� <br /> CATCH f3ASIN PERMIT FEE 3D-00 <br /> TOTAL SEWER PERMIT FEES 5 <br /> (7) MONTHLY SEWER CHARGES: <br /> SEWER CONSTRUCTION TRUCK b — <br /> LATERAL <br /> SEWER SERVICE ., � <br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAI��: <br /> CHART �C—g-Z��S <br /> INFO COM'r tI.F.D BY: DATE <br /> APPROVAL: —_ _ DATE <br /> 5 84 <br />