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f / .rx:� <br /> f ' <br /> COST ESTIMATE FOR PER�VIIT FEE CALCULATION <br /> Date: � � 1 <br /> �S - <br /> Public Works Permit No. �tdC��� / <br /> PRO.I�CTNAME: ___���Vl_�(It "` Iv�JS _ <br /> LOCATION: �ZZO I� ,v7iPi✓ `Df <br /> DEV�LOPGR: ��,� rJ��IYf SOh <--w1 S`'F'�`vG'F"�al __ <br /> Name: <br /> Address: <br /> City/Statc/Zip: <br /> Tcicphonc: �2�2?�- 235�--- <br /> CONTACT: <br /> Nam�: <br /> Address: <br /> Ciry/Statc/'Lip: __ <br /> Tcicphone: <br /> Asphalt Paving ( Sq. ft) (� ��S �, <br /> � <br /> Total of Public Improvcments $ � <br /> 'Cotat of Private Improvements $ �l �S <br /> Pur ufficc use mil�� <br /> � �r05 i Un �✓t'�-o � � _ <br /> PGRA�IIT FPE: (` I�Q. <br /> /,, � <br /> AsphaltYaving S �(/?� ?," �N[SfjG ti�T <br /> Plan Review l�ee $ ?j�� � Z�� Gs, t�� <br /> ( <br /> Inspcc[ion l'cc � ��OLJ _ <br /> Perforn�ance Guarantee $ �7.� <br /> Q.2 X cust ul Public�inprorcmcNS) <br /> 1�o�rt�►_ � �25�(0� <br /> �i��i�fG M� �i����or► - � 6, '���' <br /> ��c I�d) /�Yl��� -- <br />