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�H� <br />9 �1�ay-3 to <br />tHxH <br />tC 1-3:U W <br />�WH <br />xx ViH <br />1-3 <br />L�1 Os <br />H C7 <br />n d <br />HMO <br />luj H <br />yyH <br />rHH <br />H <br />C1 l7 �V++J <br />H y <br />i-3 0 W <br />PROJECT NAHE $oE\N4 MQ�.c'`C— S A--'vv clzX the Evergreen <br />CITYOF <br />L«acion evere-tt <br />Prrlic Works Permit 0 <br />PUELC WCAK5 OEP�ATLIENT <br />x::CCECAASTPEET <br />DEVELOPER BClrc\NGa vMM1L T itZP�AtIC r+Rx�vP nEPETr. w.SNiNG0, <br />_ SexAi <br />Address <br />City State Zip Code <br />Telephone ( ) <br />CONTACT �o1yP��pSZ�� L�o\Zsk.� <br />Name <br />Address <br />City State Zip Code <br />Telephone ( ) <br />TOTAL OF PUBLIC 11f—ROVE:`=S <br />TOTAL OF PRIVATE L`SPROV&'=S <br />ASPHALT PAVING SQUARE FOOT <br />PLAN REVIEW FEE <br />INSPECTION FEE <br />3 <br />