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DE►ARTMEt1T OF tOMMUNITY DEYELO�MENT SFRVI�ES <br />BUILDING PERMIT INFORMATION <br />.�1DDRESS _ _ <br />TYPE S'tirc.�E �a.-ni�r CZes <br />(1) BUILDRJG PERMIT FEE �4-�j,E� °D 3 4�%�50 <br />(Aj PLAN CHECK FLE P�' �� ��� �� <br />(2) PLUMBING `�S" 5�� <br />(3) MECHANICAL <br />,2{`S� 'ZZ=Op <br />(4) WATER SERVICE TO RL PAID PRIOR TO BUILDING PERMIT ISSUANCE �D�' � 7 <br />(A) TO BE DETERN,IN[D BY BLDG INSPECTOR _ INCH <br />(Bl [XIST. _ WATER SERVICE, APPLICATION NO. <br />(C) AFPROX. LOCATION <br />CHART <br />(5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDING PERMIT IS- <br />SUANCE FEEf _DRIVEWAY(TYPE) S 'G�� � � <br />S <br />(7) STATUS OF SEWER CHARCES: <br />E30ND � DISTRICT <br />NOTES <br />SC�Q�/�c� ^--�H1.L�� <br />620 /�7�—S�s� <br />/-�yv `' /79, oU <br />Sv.v� �L7/.- e b <br />---- <br />'��o b� • oz' <br />FOOTAGE <br />N, S, E, W <br />SEWER CONNECTION CHARGE� <br />YEAR �� TRUNK <br />LATERAL <br />T07AL CONNECTION CHARGES <br />SEWER PERMIT FEE <br />CATCH dASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES <br />(7) MONTHLY SEWER CHARGES: <br />SEWER CONSTRUCTION <br />g �g0_DC7 <br />$ _ 3 �o,Oc� <br />g ..`��O,Ob <br />s -3�•�� <br />TftUCK � <br />LATERAL <br />SEWER SERVICF. <br />APPROX. LOCATION OF SIDE SFWER OR TEE IN THE MAIN: <br />INFO COMPILED f3Y: <br />APPROVAL: <br />s oa <br />CHART <br />DATE <br />DATE <br />