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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 />(6) WATER SERVICE TO PE PAID PR'JR 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 <br />WATER <br />TOTAL ORD. FEE <br />SEWER CONNECTION CHARGES <br />YEAR TRUNK <br />LATERAL <br />TOTAL CONNECTION CHARGES <br />SEWER F RMIT FEE <br />$ <br />/29(0 <br />130 <br />$ .:2 <br />$ 330 <br />$ 76 <br />