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:��� <br />�� <br />.� <br />ENGINEERING�PUBLIC SERVICES DEPARTMENT <br />COST ESTIMATE FOR PERNiIT FEE CALCULATION <br />Date: ZS <br />Public Works Permit No.: ��J��� ��� <br />PROJECT NAME: <br />LOCATION: <br />� <br />DEVELOPER: ���; �''� �G'�'J�+�GvS I.I,G <br />Name: <br />Address: _ � 5� i� -� �O✓n•� C��� [,� �VZ <br />Ciry/State/Zip: I�_�i �(<°�il I�f�l �1�G'IZ <br />Contact: <br />Name: <br />Address: <br />Cih�/5tate/Zip: <br />Asphalt Paving (Sq. Ft.): <br />Total of Public Improvements: <br />Total of Private Improvements: <br />Permit Fee: <br />Asphalt Paving: <br />Plan Review Fee: <br />Inspection Fee: <br />Performance Guarantee: <br />(L2 X mst of Public !mprovemenLs) <br />Tota I: <br />Y✓i � �n <br />�_ z i , 3 z� ' <br />� <br />� �, 3SG <br />For Offce Use Onlv <br />4�00 <br />� 3�0.1�1 <br />� �4v,23 <br />� ������ �� <br />� ��ir� �'�2 <br />�iZ� tSt. � G�(�,r'r ��� . <br />2"�7wt•�2Q�i,,�,�,:•_.��1 <br />'�rc Serv���e =Tr:r, <br />�/i��,�l�l .i� t �,7;,�— <br />� - <br />� � 7- <br />�:: ��; ��;,.:,.� ��sr �,�.: � ti�„r �«<;,« � <br />/� <br />