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r� <br />.� <br />FOR OFFICE USE ONLIf <br />ADDRESS <br />(1) BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />(2) PLUM8ING <br />;3) MECHANICAL <br />(4) STATE SURCHARGES <br />(A) BUILDING CODE <br />(8) ENERGY CODE <br />(5) DRIVEWAY PERMIT <br />(6) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE <br />(A) TO BE DETERMINED BY BLOG. INSPECTOR INCH <br />(B) EXIST. _. WATER SERVICE. APPLICATION NO. <br />(7) STATUS OF SEWER CHARGES: <br />BOND DISTHICT FOOTAGE <br />N, S, E, W <br />SYSTEMS DEVELOPMENT <br />WATER <br />SEWER <br />�'OTAL ORD. FEE <br />SEWER CONNECTION CHARGES <br />YEAR TRUNK <br />LATERAL <br />TOTAL CONNECgION CHARGES <br />SEWER PERMIT FLE <br />$ <br />� <br />$ <br />�/,� 2 <br />� Z - <br />$ <br />$ <br />