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�a�,- _ _____ _ . � <br /> _. -- � <br /> i <br /> RUILDlNG PERP�ilT �NF�?RMd�T1AN � <br /> � � <br /> „ - . <br /> ADDRESS — '� %� . i, . -----' : � ------ '� __ r' ---- <br /> � � • G�� <br /> (1) BUILDING PERMIT FEE ' `� --�tL���' - <br /> CG�)OJ <br /> y H (A) PLAN CHECK FEE - <br /> � 1 C�C':U <br /> ��� (2) PLUMB!NG - � — <br /> y H =��j4,C' <br /> ���H (3) MECHANICAL - — <br /> ta+ y y (4) STATE SURCHARGES —L�, �� - <br /> � <br /> � n (A) BUILDING CODE - <br /> p� H� (B) ENERGYCODE -----�-- <br /> y y�"� ---� - <br /> (5) DRIVEWAY PERMIT ` � <br /> � O� S _ �1����� _ ��. <br /> HC <br /> g G �l,=, <br /> H <br /> H�n (6) WATER SERVICE TO BE PAID PRIOR 1'O BiJILDINU PERtitIT ISSUANCE S <br /> y y (A) TO BE DETERMINED BY BLDG. INSPECI"GR_- _`_-I:'4_..--.__ INChi <br /> 4 � <br /> t y�-3 (B) EXIST. WATER SERVICc APPLICATION NO. ___--_____ ! <br /> gdC y (7) STATUS OF SEWER CHARGES: I ` <br /> trJ� BOND_T�__ DISTRICT _ _ __-__ FOOTAGE .__ — _ __ II <br /> N, S, E. W <br /> H O fyi� I <br /> UHDINANCE 7171-f35 ��,� � � <br /> WATER —"`�`-�— � <br /> L�. I <br /> ! i.)l.j� Q � (�11 II i�i' SE`NER I <br /> c, �CG� <br /> =" �'> TOTAL ORD. FEE '- J— '' <br /> ,r�, �1-�, i�! V� 6�, � ���� �; — ' <br /> .�� \/ I r SEWER CONNECTION CHARGES r� <br /> �`'. ..;.../� JI ` �J1_- l �.' .}_ _��� � �� <br /> ._� `-' YEAR _ _ _ _ _ TRUNK S , <br /> ` r ` -- <br /> ���t'1��� �IS �Y� ; 1 - LATERAL - .-�r, <br /> p TOTAL COIVNECTiOP! CHARGES S _ '���� <br /> ��� ���'� rJfU � f �� �' � � �� � <br /> �_. <br /> �� �� � .V•i L IC � 3 S 7'��(0 % � SEWER PEF^�IT FE[ � _ �� <br /> ��� <br /> ' _ . '-�`' � ' ,�� i <br /> � � , <br /> �'� <br /> �o �;r <br /> =, <br /> � <br /> _.__ ,_ <br /> :� <br /> ��p� <br /> L�� ! <br /> -_� <br /> I 7fip I � <br /> 7 G (lf___— �.I , <br /> � �(, 7 Oc) � <br /> I�. � <br /> - <br />