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f,�: - . <br />��..„ <br />1/ ' �� <br />r� , <br />,,�.,,"� <br />�. ,. <br />ENGINEERING/I�UBLIC SERVICES DEPARTMENT <br />COST ESTIMATE FOR PERMIT FEE CALCULATION <br />Date: Q ��2co� <br />Public Works Permit No.: 1����701-�1 � <br />PROJECT NAME: �E-s� n'In����� Jl�y-+ �l�'we- Irn��v�n�ntr5 <br />LOCATION: <br />DEVELOPER: <br />Name: <br />I'��=` `�TQ�T �I- �,�1 MY i� <br />�C�G.'T O'F ����ET� <br />'�UL1 LlA1� <br />Address: 'Z�i 1 I ��vNt� c.5�. , SU�-�. zvZ <br />City/State/Zip: Evt� L�tc , �J A <br />Contact: <br />Name: ��oil�J IMrn+ - L�nv��� l,^-Jnr�s � -�,-�c. <br />Address: 1��' U�.�J .�����N� �icyJ T_�. ,� S�-�z�-' <br />Ciry/State/Zip: 'C�vE-�'-�T � a"`I l� `��'_'Zv I <br />Asphalt Paving (Sq. Ft.): � � "� �� <br />Total of Public Improvements <br />Total of Private Improvements: <br />�����89. � <br />� v. o� — <br />For Office Use Onlv <br />Permit Fee: <br />Asphalt Paving: <br />/9p� 9t3`I <br />Plan Review Fee: X�, p/5 <br />Inspection Fee: / 9D 98') <br />XL!0� <br />Performance Guarantee: <br />(1.2 X cost of Public I�nprovements) <br />Total: <br />OEDI�On00YS/COSf ESf�CERNR fEE ULC <br />$ :� R �� S <br />� 57� <br />a 3S9 � <br />