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F <br />: <br />� <br />� <br />FOR OFFICE USE ONLY <br />ADDRESS <br />(') BUILDING PEHMIT FEE <br />(A) PLAN CHECK FEE <br />(2) PLUMBING <br />(3) MECHANICAL <br />(4) STATE SURCHARGES <br />(A) BUILDING CODE <br />(B) ENERGY CODF <br />(5) DRIVEWAY PERMIT <br />(6) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE <br />(A) TO BE DETERMINEO 8Y BLD(3. INSPECTOR INCH <br />(8) EXIST. WATER SERVICE. APPLICATION NO. <br />i <br />(7) STATUS OF SEWER CHARGF.S: <br />BOND DISTfiICT FOOTAGE <br />N, S, F W <br />SYSTEMS DEVELOPMENT <br />WATER <br />SEWLR <br />TOTAI.ORD. FEE <br />SEWER CONNECTION CHARGE£ <br />YEAR TRUNK <br />LATERAI <br />TOTAL CONNECTION CHARGES <br />SEWER PE'�MIT FEE <br />S _ <br />3 <br />� _ /D `_� � <br />—_1�•� % �o <br />a — 4 <br />S <br />