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y H <br />�i '� <br />� N <br />� H t/i <br />��� <br />'tl Mhtl <br />�yp� <br />H <br />G <br />��8 <br />{ij Y �] <br />H <br />~y' H <br />� yH <br />g�y <br />�O� <br />�� � <br />�� <br />i �I 1 <br />' ���' <br />rv <br />BUILDING P��iMfT INFORMATION <br />ADDRESS __ <br />(1) BUILDING PERMIT FEE <br />(A1 PLAN CHECK FEE <br />(2) PLUMBING <br />(3) MECHANICAL <br />(4) STATE SURCHARGES <br />(A) BUILDING CODE <br />(B) ENERGYCODE <br />(5) DRIVEWAY PERMIT <br />(6) WHTER SERVICE TO BE PAID PRIOR TO BUILDING PER�v11T ISSUANCE <br />(A) TO BE DETERMINED BY BLDG. INSFECTOR _— INCH <br />���� b <br />(B) EXIST. �_L�-- W�TER SERVICE APPLICATION NO. _— —_— <br />(7) STATUS OF SEWER CHARGES: <br />BOND_—__ _ __D!STRICT_—__—FOOTAGE.____-- <br />N, S. E, .: <br />�C�IV /1/ U�� <br />C��7�v'1 rL�l� �� Y � � <br />ORDINANCE 1171-85 <br />WATER <br />SEWE'r7 <br />TOTAL ORO. FE[ <br />� -- <br />S ��j, �%j = <br />s __ �� S<�- ���' <br />—�/ - Z% � �- �' .---- <br />_�[?/. �ilL___ <br />—.�!_`J��1, c'/,' <br />SEWER CONNECTION CHARGES <br />YEAR__ — _.._ _— TRUNK 5 _— — <br />LATERAL — — <br />TOTAL CUNNECTIO� CHARGES 5 — ----- ' <br />SEWER PCRMIT FEE <br />CO 3 '5��.% � <br />-�oUv <br />s — �3 0, 07; -- <br />