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1.00 ApplicationGørfield CountY PAYMENT AGREEMENT FORM ("APPLICANT') GARFIELD COUNTY Lfrw vto' ¡rcouNTY")agree as follows: LO 1. The APPlicant county an A €-a t Þ I hereby agree to pay all fees related to this application: Billing Contact Person:L¡r¡(e')¡.e-- D¿o-ro) for the following Proiect: S 3 d37 C. Phone:Lx 76o- (s k7 cJ ,/L L 2.îheApplicantunderstðndsandagreesthatGarfietdCountyResolutionNo,2014-60,as amended, establisies a fee scheiule for each type application' and the guidelines forthe administration of the fee structure' 3. The Applicant and the county agree that because of the size, nature or scope of the proposed pro¡ea, ¡i is not poss¡ble at this t¡me to âscerta¡n the full extent of the costs involved in processing the application. The Applicant agrees to make payment of the Base Fee, established for tie proiect, and to thereafter permit additional costs to be billed to the Applicant. The Applicant agrees to make additional payments upon not¡fication by the County, when they are necessary, a5 costs are incurred' 4. The Base Fee shall be in addition to and exclusive of any cost for publication or cost of consulting service determined necessary by the Board of County Commissioners for the consideration of an application or additional County stafftime or expense not covered by the Base Fee. lf actual recorded costs exceed the initial Base Fee, the Applicant shall pay additional billings to the county to reimburse the county for the processing of the Project' The Applicant acknowledges that all billing shall be paid prior to the final consideration by the County of any Land Use Change or Division of Land' Billing Contact Address: / o C Sqop\e tu-o f¿t Cíty:C s,.t" ¡ o^\a*state: cl Zip code:år k zs Billing Contact Email:I J-.:fo ù ç @ t tfl r(-. c. f'ì Printed Na Authorized to Sign:L s ,¡ (q J<-¿- N I tor" \ 2 -za- Zo {Signature}(Date)