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Public Works Reviewer to Calculate and Fill Out All Information Below: Permit #: Pw�5�2-007 <br />I <br />❑ YES -Type <br />� NO �—" <br />Fire Department/Code) <br />. <br />� �; ,.• � ' � �. , ,._ <br />, Reaso ;L.- '��' ��'i� '��,'' � 2-� ,�.,,'' �'{� <br />r..n ,..,; , <br />(Note: Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br />WATER FEE? <br />❑ YES - Amount $ <br />❑ Meter Only, ❑ Complete Service, Type/Size <br />�N O <br />Ex U Permit # <br />Explanation: -(J5� <br />SEWER FEE? ��- � �� Z�� �� <br />� <br />❑ YES - Amount $ a � <br />❑ New Connection, ❑ Alteration/Repair, <br />❑ NO <br />Ex U Permit # <br />Explanation: <br />��y �� S. <br />,.�-�� <br />Cap-o Reconnect <br />SY TEM DEVELOPMENT FEE? <br />NO - No Change of Use / Other� �l��� � <�c �. ��; , <br />❑ YES - Amount $ <br />❑ See Attached Spreadsheet <br />Explanation: � 3y55n� hc�,� •-�?,�- �i hr�u,�.'�,r = (Jl�'�ih.- <br />(Note: Public Works Reviewer to Add Traffic Mitigation to PW Permit (if applicable)) <br />TRAFFIC MITIGATION FEE? � <br />❑ YES - Amount $ <br />�N o �i,��„ ��� <br />� � W• <br />Public Works Reviewe <br />❑ See Attached Spreadsheet �(� �' <br />•,� �'i� <br />� � �� <br />� ( 2� � 3 t�fs - �o� ��- � �- �� _ ���-�> <br />�k�'i�,J� �1,�� -� lG� o� �' �� �Cv.f,r'�c+ct,i� �� ���'J <br />ature Date <br />