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0 FOR OFFICE USE ONLY 0 PERMIT # ,i311 UA O <br />Pj+I7l:-V <br />FEES <br />INTAKE: Checked B : Date: <br />Comments: J%S d�% iqr- <br />(f'j"' M"a <br />High Hazard Sites (Dental/Medical, Animals, Mortuary, etc -Review for RPBA) <br />❑ Public Works / Sys Dev / Traffic Mit. / RPBA - NOT REQUIRED <br />IR Route for Public Works Review (bldg folder, PW Worksheet) <br />❑ Public Works Perm it-Concurren Review (separate gre n ff Ider) <br />Plan Check Fee <br />Building Permit <br />Surcharge <br />Additional Plan Check <br />Plumbing Fee <br />Mechanical Fee <br />Ping Bldg Review Fee <br />PW REVIEW: PW Reviewer: Date: <br />WW Permit Approved - PW !Soq xq <br />See PW Review Worksheet <br />❑ PW Permit Not Required <br />Water Fee <br />Sewer Fee <br />Systems Dev. Fee <br />Traffic Mitigation Fee <br />Public Works Fee <br />FIRE DEPARTMENT <br />School Mitigation Fee <br />Update/New Sprinklers <br />Yes _ No _ Existing Bldg._ <br />Update/ New Detection <br />Yes No Existing Bldg. _ <br />Update/ New Chemical <br />Yes No Existing Bldg. _ <br />Update/ New Fire Service <br />Yes No Existing Bldg. _ <br />Approved by: Date: <br />Comments: <br />/� Z <br />