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FOR l?FFICE USE ONLY <br />ADDRESS - <br />(t) BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />(2) PLUMB�NG <br />(3) MECHANICAL <br />(4) STATE SURCHARGES <br />(A) BUILDING CODE <br />(B) ENERGY CODE <br />(5) DRIVEWAY PERMIT <br />(6) WATER SERVICE TO BE PAID PRIOR TO BUILDPNG PERM T I SUANCE <br />(A) TO BE DETERMINED BY BLDG. INSPECTOFi �- INCH <br />(B) EXIST. WATER uERVICE. Af'PI_ICATION NO. <br />(7) STATUS OF SEWER CHARGES: <br />BOND DISTRICT FfJOTA3E N, S. E, W <br />SYSTEM'S OEVELOPMENT <br />WATER <br />SEWEN <br />TOTAL ORU. FEE <br />SEWER CONtiECT10N CHARGES <br />YEAR TRUNK <br />�ATERAL <br />TOTAL CONNECTION CHAFiGES <br />SEWER PERMIT FEE <br />$ <br />� <br />$ - <br />$ <br />$ <br />� <br />i / (, <br />/� � lv <br />