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,%�e��sed 6 -/��-o.� <br /> � ENG.,.FERING/PUBl1CSERVICESD��ARTMENT <br /> '` Ev Er�' <br /> COST ESTIMATE FOR PERMIT FEE CALCULATION <br /> Date: � � � �� <br /> Public Works Permit No.: �'�✓ 0'�0> '�"� <br /> PROJECTNAME: �C) M�.��U� �T'�'1 �� L/� �"G-t'� CC��(�� <br /> LOCATION: � C�C� 9 L V�= f�G' I�G�%l1� k�F�'�1 <br /> DEVELOPER: <br /> Name: <br /> Address: <br /> City/State/Zip: <br /> Contact: r (� n <br /> Name: �l �5� � v[ I�.L�� � /�C��l il � <br /> Address: t1235 S� ('�`f �" 5=-lr7`C �zC� <br /> City/State/Zip: �J�= LL •L"-'�/�pL ��, ���U '�{' <br /> «-z51 453 - :% 7� i <br /> Asphalt Paving (Sq. Ft.): <br /> Total of Public Improvements: $ <br /> �ni , � <br /> Total of Private Improvements: $ <br /> -- - --=— --__ _ <br /> For Offte Use OnIY <br /> Permit Fee: <br /> Asphalt Paving: $ <br /> Plan Review Fee: $ `�> �;' , !' �- <br /> Inspection Fee: $ � ?� . �''�� <br /> Performance Guarantee: $ <br /> (1.2 X cos[of Publi[Impravements) <br /> n � <br /> Total: $ -- -� �- -'� <br /> r�ouoaoowcosrEsr�oEar+rrrcecuc \f� <br /> 1 <br />