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2~ High Strut NE .............. <br /> <br /> DWELLING/STRUCTURAL AND/OR SEPTIC PERMIT APPLICATION <br /> COMPLETE ALL SECTIONS, I THROUGH 4 ~ ~ <br /> 1, Job Description ~ m m ~ ~ ~ <br /> <br /> [ I Addni~ I I ~o [ ] Altcr~i0a [ ] O~cr <br /> [ } Alter~i~ [ ] O~r la~[~ 00~ I I ~ng~an~ <br /> <br />2 LOCatiO~ of Installation <br /> <br />Contractor information <br /> <br />Madmg AdO,~S & phona N~- <br /> <br />5. Fee Schedules <br /> <br />A.. New One.and-T~o Iaamdy E~e]ling Go& <br /> (includc~ El, Ma, PI) <br /> <br />(1),Sq. F~- _ x 28 <br />C~) 5% ,~.l~ Surcharge 605 x Al) <br />(3) Base l'~,*e for Plan R~viaw <br /> <br />(I) Pcrmit Fcc <br />(2) 5% State Su rcha~g~ ( 05 × B I ) <br />(3) Y~,n[ng Surcharge (05 x <br />(4) Pbns Che4k (-6~ X Bt) <br /> <br />(I) Driveway ~/~urb (o~ $7.50 <br />(2) Driveway w[o corb @ $17 ~ <br />(3) Si~ Plan Revm~ (~metcia] <br />(4) I~liga~t~ F~ <br /> <br />(6) O~ler m~eti60~ not lt~t~ <br /> <br /> = <br />gubtotal: =S- <br /> <br />Valuation; <br /> <br /> <br />