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FOR OFFICE USE ONLY <br /> ADDRESS -------- <br /> III BUILDING PERMIT FEE 5 <br /> (A) PLAN CHECK FEE - - - - - <br /> (2) PLUMBING - ---- -- <br /> (3) MECHANICAL ----- - - --- - <br /> (4) STATE SURCHARGES -- -- <br /> (A)BUILDING CODE - --- <br /> (B) ENERGY CODE - <br /> (5) DRIVEWAY PERMIT <br /> S <br /> (0) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE SA 9987 <br /> (A) TO BE DETERMINED BY BLDG.INSPECTOR INCH F11-411'7 I <br /> (B) EXIST. WATER SERVICE,APPLICATION NO. <br /> (7) STATUS OF SEWER CHARGES: <br /> BOND DISTRICT _FOOTAGE <br /> N. S. E. w <br /> SYSTEMS DEVELOPMENT <br /> WATER <br /> SEWER <br /> TOTAL ORD FEE <br /> SEWER CONNECTION CHARGES <br /> YEAR__ TRUNK $ <br /> LATERAL -- - <br /> TOTAL CONNECTION CHARGES E _. <br /> SEWER PERMIT FEE S <br /> I <br /> i <br /> i <br />