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� � <br /> FOR OFFICE USE ONLY <br /> ADDRESS <br /> (1) BUILDINGPERMITFEE s _ <br /> (A) PLAN CHEGK FEE <br /> (2) PLUMBING <br /> (9) MECHANICAL <br /> (4) STATE SURCHAPGES <br /> (A)BUILDING GODE <br /> (B) ENERGY CODE <br /> (5) DRIVEWAY PERMIT <br /> E <br /> (6) WATEP SERVICE 10 BE PAID PRIOR TO DUIIDING PEHMIT ISSUANCE E <br /> (A) TO BE DETERMINED BV BLDG.INSPECTOR INCH <br /> (B) EXIST. WATER SERVICE.APPLICATION NO. <br /> (7) STATUS OF SEWER CHARGES: <br /> BOND DISTRICT FOOTAGE <br /> N, 5. E W <br /> SVS7EM5 DEVELOPMENT <br /> WATER <br /> SEWER <br /> TOTALORD.FEE <br /> SEWER CONNECTION CHARGES <br /> YEAR TRUNK f <br /> LATERAL <br /> TOTAL CONNECTION CHARGES E <br /> SEWER PERMIT FEE E �U <br /> Cr,s�. L�� G�z� 910.��"0= <br /> ; i! i� 2" a'.�„ c:,� (,�9o��n3o <br /> 1., «- :�30 C'3� <br /> �;lu}!/� 70 /13'L <br /> — —G-.f'�'9 .��.ir! _ - _— <br /> �' 1 ���n� �3a U 99��-0.33 <br /> \'r�Es s 3 3� — <br /> 1 , . �,n� 5;;v 9908 039 <br /> .;�„ �-,_ �v U <br /> !' .r ,�_�1 F�i 39G — <br />