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� -. <br /> BUILDING PERMIT INFORMATION ' ��� � <br /> ADDRESS <br /> (1) BUILDING PEFlMIT FEE g _ <br /> (A) PLAN CH�CK FEE <br /> (2j FLWMBING ` <br /> , (3) AIECHANiCAL � ' � <br /> (4� STATE SURCHARGES <br /> (A) BUILDING CODE <br /> (B) ENERGYCADE <br /> (5) DRIVEWAY PER�91T <br /> . $ �� <br /> (6) 'JVATER SERVICE TO BE PAID PRIOR TO BUILD'NG PERMIT ISSUANCE $ _ �Q� <br /> (A) TO 8E DETERMINED BY BLDG. INSPECTOR INCH � � ' <br /> (� EXIST. "' WATER SERVICE APPUCATION NO. <br /> (7) STATUS OF SEWER CHARGES: <br /> BOND__ DISTRICT FOOTAGE <br /> N, S, � W � <br /> ORDINANCE 1171-85 p <br /> WATER I �7 <br /> � SEWER LI7I <br /> TOTAL ORD. FEE /oJ�� <br /> SEWER CONNECTION CHARGES �•;, <br /> YEAR TRUNK $ � <br /> ,t:.�r.:, <br /> LATERAL <br /> TOTAL CONNECTION CHARGES $ '�" ' '- <br /> SEWER PERMII'FEE $ �� <br /> ��ii;:.; , � <br /> ... . . a6t' � . <br /> �. <br /> . . ..�ht���i' ti <br /> i <br /> i <br /> r <br /> j <br /> .... ,. � . i �•� � <br /> � .�. ..... ,�. I . .. , � <br /> . . .. . . . � I ; .. ' <br /> � <br />