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FOR OFFICE USE ONLY <br /> ADDRESS <br /> (1) BUILDING PERMIT FEE $ <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 /> (6) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE $ �� <br /> (A) TO BE DETERMINED BY BLDG. INSPECTOR INCH <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 n <br /> WATER AL3 Z <br /> SEWER 91/7/ <br /> TOTAL ORD. FEE <br /> SEWER CONNECTION CHARGES <br /> YEAR_ TRUNK $ <br /> LATERAL <br /> TOTAL CONNECTION CHARGES $ <br /> SEWER PERMIT FEE $ _ 7/� <br />