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<br />B'P�anc�</ 3 4 5• 4 7+
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<br />ADDRESS ,�,�,,, �- �, � y �• 7�-
<br />(1) BUILDING PERMIT FE 'y��L �
<br />�L �ti/ 4 • 5 +
<br />(A) PLAN CHECK FEE Zv% 3� 1 0 5• 4 2 r
<br />(2) PLUMBING
<br />(3) MECHANICAL
<br />(4) STATE SURCHARGES
<br />(A) BUILDING CODE
<br />(B) ENERGY CODE
<br />(5) DRIVEWAY PERMIT
<br />� 1 0 5• 4 2+
<br />ae2o•�a—
<br />' 2 6 4• 7 4�
<br />�,.,-� ow� -�� r
<br />-�,i,�G�a r�PI.L
<br />��� ��� �
<br />�
<br />' INFORMATION
<br />�(6) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE
<br />(IU�TO BE DETERMINED BY BLDG. INSPECTOR �� INCH
<br />(B) EXIST. WATER SERVICE APPLICATION NO.
<br />(7) STATUS OF SEWER CHARGES:
<br />BOND
<br />r
<br />OISTRICT FOOTAGE
<br />N, S, E, W
<br />ORDINANCE 1171-85
<br />WATER
<br />. ����.���:�
<br />TOTAL ORD. FEE
<br />SEWER CONNECTION CHARGES
<br />YEAR
<br />LATERAL
<br />TRUNK
<br />TOTAL CONNECTION CHARGES
<br />SEWER PERMIT FEE
<br />$
<br />$
<br />$ �o�
<br />30���
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