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r+ <br /> E�7NEERlM�P���LI�SERVIC�D�EPAI�TM�VT <br /> COST ESTINIATE FOR PERMIT FEE CALCULATION <br /> Date: 4. .�[ [,. <br /> Pubtic Works Permit No.: w � G`�"�ZZ <br /> PR07ECTNAME: ��� � ir( f In �.• � c�>iini� e �� �r: ( <br /> LOCATION: >2�� l< ) (n • i� ��� /��� I- v � �� t� - <br /> DEVELOPER: _ <br /> Name: �iu�� ( � 7u � �_ <br /> Address � C� �7 C� �� (c�l �` l�� (A 1 <br /> City/State/Zip; rll,�_�1�uT_lA '/1 ` f� 7 l� <br /> co�tact: <br /> , � <br /> Name: ���, , � 15r � �� � �i� �ir � � �� i�, _ <br /> Address: �I � Z`) 7G.�" S� f✓E .`�'L� . �D'/ <br /> Ciry/State/ZiP: �� x� � � llc �� ` S .,1 C� <br /> Asphait Paving (Sy. Ft.): �' �,4 ��zA �� <br /> Total of Public Improvements: $�`% � 'n <br /> Total of Private Improvements: $_ � � - - ---(!f"� <br /> dy � ��l-� �'f��� 0 c� £l' <br /> _� _,.. -. _ , _._ .� . --� ---- �-.�..� -.� �.__�_.- z__y_n,��-„�_ z <br /> �ui OfficG..Use Only <br /> Permit Fee: �:j <br /> Asphalt Paving: 3 � � � I � - <br /> / � <br /> Plan Review Fee: $ ' J ��_� - <br /> [nspection Fee: 5 �l' � G <br /> Pcrformance Guarantee: $_ _ <br /> �: ; � ��tit.ir Pi,hh�. Iinprovenir.nis) y S <br /> .t , �. <br /> Total: $___ — <br /> f�fD1.9�tM�5':.,J`.T li vcP���l !{[ iAl. <br /> .� <br />