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� <br /> i <br /> f����A_,������ ����Gii�G`u nGA�;{';����':�Gu��i�6�`�� f�,�;� <br /> ADDRESS — ' I <br /> (1) BUILDING PERMIT FEE "� <br /> (A) PLAN CHECK FEE <br /> i <br /> (2) PLUMBING {' <br /> Kj�� (3) MECHAhICAL ' 1 <br /> ci n� (4) STATE SURCHARGES � � <br /> r'��' (A) BUILDING CODE I <br /> � �� (B) ENERGY CODE <br /> � x p (5) DRIVEWAY PERMIT — —J � <br /> � H� S — <br /> Vl H — <br /> xz� �,p <br /> t�1 y`'�' //���— I <br /> (6) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERIv71T ISSUANCE $ -LL <br /> �h� (A) TO BE DETERMINED BY BLDG. INSPECTOR__��;_-_----. INCH <br /> ay� (B) EXIST. WATER SERVICE APPLICATION NO.__.---- <br /> r H y (7) STATUS OF SEWER CHARGES: � <br /> o y�' BOND DIST�ICT_ — FOOTP.GE_ .___. _-_- � <br /> n b p� N, 5, E, W � <br /> � �Ch <br /> �3 ovi ORDINANCE 1171•85 <br /> VJATER - /� �n� � <br /> SEWER rfi 7 C'� <br /> T�TAL ORD. FEE � �' �� _ ± <br /> � <br /> "'� SEWER CONNECTION CHARGES <br /> �� YEAR_.__-__-- TRUNK 3 - � <br /> 'o� LATERAL -"- �' <br /> i <br /> '�� TOTAL CONNECTION CHARGES � - � <br /> �� ���� � <br /> �� SEWER PERMIT FEE � ---- -- <br /> fl <br /> � ;9 <br /> �� <br /> �'= i <br /> 7, <br /> f <br /> � ` <br /> +�s <br /> ; <br /> __ � <br /> � <br /> � <br /> I _ <br />