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BUILDING PERMIT iNFORMATIORI <br /> ADDRESS _ -"-- ---- <br /> 11j BUILDING PERMIT rEE � - <br /> (A) P!AN CHECK FEE — <br /> (2) PLUI.�JING <br /> (3) MECHANICAL - <br /> F� � (41 STATE SURCHARGES - - <br /> � �� IA) BUILDING CODE <br /> G�H (B) ENERGY CC�DE - <br /> y (5) DRIVE`NAY PERMIT <br /> H � s --��'Z= .: <br /> K � <br /> H 70 /�,h �,.� <br /> �yM .�1.(�1-�� __.-_ <br /> (6) WATER SERVICE TO BE PAID PRIOR TO BUILDINci PER./MIT ISSUANCE 5 — <br /> x (A) TO BE DETERMINED BY BLDG. INSPECTOR_�1.�I-- ___ INCH <br /> o �� <br /> (B) E�CIST. __WATER SERVICE APPLICATION NO. _ <br /> n <br /> �� � (7) STATUS OF SEWER CHARGES: <br /> � y"� BOND D�STRICL_______- FOOTAGE__ _ _ - <br /> x -- --- N. s. e w <br /> CN ly <br /> �c�i C t~n ORDINANCE 1171-85 / ��, JU <br /> � '�" WATER � <br /> o cyn S[WER =����'.�-- <br /> TOTALOR0. PEE _-_--=_'-1�--"-`•__ -_ <br /> �' -- <br /> SEWER CONNECTION CHARGES <br /> �� YEAF -_- - -- - _--TRUNK S -- — <br /> - --- <br /> LATERAL ---- ----- <br /> TOTAL CONNECTION CHNRGES S __ ___ <br /> � L� -�/� <br /> SEWER PERMIT FEE � ---- ----�-�/'��� <br /> � �1 1 <br /> �-1 i <br /> ����. <br /> ��l(`._i �� ;�.:.J >�(�-C� <br /> � �=�''_. <br /> G�/ r7 3�1 <br /> � <br />