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FOR OFFICE USE ONLY <br />ADDRESS <br />(1) <br />BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />(2) <br />PLUMBING <br />(3) <br />MECHANICAL <br />(A) <br />STATE SURCHARGES <br />(A) BUILDING CODE <br />(B) ENERGY CODE <br />(5) <br />DRIVEWAY PERMIT <br />(5) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE $ L�`' <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 <br />WATER <br />SEWER <br />TOTAL ORD. FEE <br />SEWER CONNECTION CHARGES <br />YEAR_ TRUNK <br />LATERAL <br />TOTAL CONNECTION CHARGES <br />SEWER PERMIT FEE <br />$ <br />$ <br />$ �J <br />