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F�t; OFFICE iJSE aBdLY <br /> ADDRESS_ <br /> (1) BUILDING PERMIT FEF � <br /> (A) PLAN CHECK FEE <br /> (2) PLUPABING <br /> (3) MECHANICAL <br /> (4) STATE SURCHARGES <br /> (A) BUILDING CODE <br /> (B) ENERGY CODE <br /> (5) DRIVEWAY PE!�MIT <br /> $ <br /> (6) WATF.R SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE � ���� <br /> (A) TO BE DETERMINED BY BLDG. INSPECTOR_ INCH <br /> (B) EXIST. WATER SERVICE. APPLICATION NO. <br /> (7) STATUS Oi= SEWER CHARGES: <br /> BOND_ DISTRICT F70TAGE <br /> N, S, E, W <br /> SYSTEMS DEVELOPMENT <br /> WATEr� L�-�C.� <br /> SEWER I� J� <br /> TOTAL ORD. FEE _ �I/���� <br /> SEWER rONNECTION CHARGES <br /> YEAR TRUNK $ <br /> LATERAL ! <br /> TOTAL CONNECTION CHARGES $ / <br /> SEWER PERMIT FEE $ /( J <br /> �Pc,AN G�t� C.� � <br /> � ,,,,�.� "'`'�,� " <br /> �s t� ► �% � � - � <br /> � �� � � <br /> � ��� ,�� �� <br /> p- g.�a s`� � �;',' ,u; , <br /> , �c�n� � ��'� <br /> c��' ,�°t� t�V � <br /> ��� �`��-, ',�� �� ; L.L% . <br />