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Permit Miscellaneous 1991-11-14
J\!le t 1-0 pO Ii tC:Ul V'Ja.stewa.ter JV\a.IIClgemellt Commissioll . . l ....".'. .'.': . ': ~ ~ ..:.. ;" '. r., '. ':-r::~t:,~ c;;~.~ ~ ';,;:::" ~:~'.;. i:~:~i.-~t'~i:;'\t l?i ;:,!';'i~!{,,:..;I,{ ~:::; ~;;~:.:":; -~: ....;:;ti:ll~i ;;(';;'t :t::;,:;i','l; C. '::. ~~.:~:.~,-S;>'iP.1:i(:iO C::""lc;i:'~l~.(.;'l '.: ':i.:~:'~-l~;,i C~\!;-,:r lri =,i':"!,~~"'::(.:'r~ ::;', :;.;;~I-~,,'1(. CN~~,;,' c~,';,.:-'l:: ~::;J[I t.:;:._ \':! ;:!:n~-: t:; t1f' l~, ;:,~: :l'~ (;-,:r.:I.'C /-;::--..: ;..:-:D .:., 5:F.::=IS - Sr:r,::-~GF!ELD CITY !-:,:'.LL - ~;::;:;:;':Gl-:ELD, CF.Ese:'! ;:7,:77 "r:::L!.:?:--:C:<:: (:.Cr3) 7':7.':S:;i 1'.\!11C CONNECTION CHARGE Building Address: (C/-4/J. \\~~,()JnoO~ Referenc~ber: 'll0~(':)01\~_ (1' Tax Lot "umber: rrT-7CfJ O.'ner: ('\_~!J O(t)l() f;-(I /LJ ( VI-nil "\ ~.ddress:~ To ("vu '. Phone Number: l.oRt;;:q( 2_3; Citj': rJ ')C:,Q,/12 / State: ~. rO/t Q(dJ!0Zip: q'74()2~ (j k () ~ /' .........- Residential Fee <$222.00) $c9!}Q ,CC) Commercial Fee <new non-residential development/ remodel) Total fixture unit charge (see reverse of this form) $ Credit Due (see reverse of this form) SUBTOTAL $ <$ cOl.i\"c~ > TOTAL H\IMC CHARGE $ IQLl.CS5 BlI il'd i ng By: c\~~ Job Ilumber: q/ Obg2~ Date Received\\- \\....\-C\ \ Receipt Number: ~IO~ Received . . ri:,:ture U!lit C31culatio;1 Table: ~:umber of roe-.' fi:.:t\lrQs .:,ultipliEd by unit ~qUi':.1!E:1tS. ~'~(/i'~: i-~or rE:;,nodels~ c21cul~te only t!-,e ::ET .:dditioD<1.1 [i;.:tures. ? i:.: t 'Jl,.'e T:I'p'2 # of Unit FixturQs Equivalents Fixture Units ::;; th tub. . . . . . . . . . . . . . . . . . . . . . . . . . . .".. . . .. . . ~rinking fountain......................... rloor drain..............,................, interCEptors for grease/oil/solids/etc".. Interceptors for sand/auto vash/Etc...., , . L2.undry .tub/clothes '\"'asher. :'"............. C10thES ',,':~.shE:r (3 or more)................ ~~Q~ile !'o~e ?ark trap (1 per !1.~,)...,.... ~eceptor for refrig/~ater station/etc..... ~Eceptor for Coc~er sink/dishvshr/etc... ,. Sho':er, s:ngle .stal1................".." Sho"Er, go.ng (per heo.d)................... Sink, bar, co~mercial........ .... ......... Sink, cOJimercial/industrial/etc........... Urnial, sto.ll/"al1.,....,......,.......,.. ~ash bo.sin/lavatory, single..,. ... ..... ,.. .'ater closet, public installation......... :.: ate reI 0 set, p r i ... 2. t e. . . . . . . . . . . . . . . . . . . . . !~iscellaneous: .... ...... 2 1 2 3 6 2 6 6 1 o ~ 2 1 2 , ~ 2 1 6 4 Total Units: Tot2.1 fixture units x $13.25 each = Toto.l Charge: $ Credit Calculation Table: Based on total value of property at time of permit application. Year ';~nnexed to the ci tv Credit per $1,000 assessed value I~ 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 $2,65 $2.64 $2.53 $2.41 $2,19 $2.04 $1. 69 $1.35 $1.15 ;:0.92 $0.59 $0,23 gate :< S tb ,"??AJ J..ssessed V2.1 ue = s ~') .4S Total Credit Credit