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� , � <br /> � ' �'J <br /> 1 <br /> i <br /> ; <br /> � �UIL101INC PERMIT INFQRIUTA`�bON <br /> , <br /> S ADDRESS Sa; R' - 1 a�`� P�,�_ <br /> (1) BUILDING PERMiT FEE <br /> $ -- �-U'`/�.,�� <br /> (A) PLAN CHECK FE[ — <br /> (2; PLUMF3ING __�� <br /> (3) MECFiAiVICAL __ c� U` <br /> (4) SiATE SURCHARGES <br /> (A) F3UILDINGCODE __�s-^ <br /> (B� ENERGYCODE Sf <br /> (5) Di�IVEWAY PERMIT <br /> - _ZU`"C�--- <br /> � _ cP <br /> . �—.. <br /> , � � <br /> (o) WATER SERVICE�O BE PAID PRIOH TO BUILDING PEr^,MIT ISSUANCE $ _��a�_ <br /> (A) TO BE DETERMINEU BY BLDG. INSPECTOR ����_ INCH <br /> (B) EXIST. WATER SERVICE APPLICRi ION NC'. <br /> (7) STATUS OF SEWER C�-'ARGES: <br /> BOND_� DISTRICT____ FOOTAGE_____ __ <br /> N, S. E, W <br /> ORC \NCE 1171-85 . <br /> " WATER _ � -� �� OG <br /> ; SEWER —�� --- <br /> U <br /> ; 7;7TAL ORD. FEE �p s�= <br /> '' SEWER CONNECTION CHARGES <br /> � YEAR � <br /> _ TRUNK $ _,__�[�__ _ <br /> LATERAL �" <br /> < — <br /> ", TUT.4L CONNECTION CF±ARGES $ __ I�r� <br /> � <br /> SEWER PERMITFEE $ _ __�S(J _ <br /> � <br /> ������� <br /> C oZ <br /> 1 � 9 . U� <br /> , , <br /> ; <br /> ; <br /> � <br /> � <br />