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� <br />PROJECT NF�I��E: <br />LOCATION: <br />DE��EI.OPE R <br />'UBL/G' f�/Ol�KS <br />COST ESTIMATE FOR PERMIT FEE CALCULATION <br />Name: <br />Address: <br />City/State/Zip: <br />Telephone: <br />CONTACT <br />Piame : <br />Address: <br />City/State/Zip: <br />Telephone: <br />DATE B f� <br />PUBLIC WORKS PERMIT N0: <br />/ U ��/ <br />(/SZI - E✓LY9%CGN WC.��/ _ <br />� � <br />) <br />TOTPS. OF PUBLIC IMPROVEMENTS <br />TOTAL OF PRIVATE IMPROVEMENTS <br />ASPHALT PAVING '(__ �� O_� S� FT) <br />T <br />PLAN REVIEW FEE <br />INSFECTIODi FEE <br />TGTAL <br />PERFORMANCE GUARANTEE <br />$ <br />$ 7Z/G°� <br />$ 80 oa <br />$ Z8 B6 <br />$ ��J/� `f_� <br />$ <br />$ <br />CITY OF EVERETT• 3200 Cedar Street • Everett, WA 98201 •(206) 259-8800 � Fax (206) 259-8856 <br />0 <br />