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rW -r� ,.,: APPLICATION for <br /> fr= r ' PUBLIC WORKS PERMIT <br /> PUBLIC WORKS DEPARTMENT <br /> t. I': ! 'FITft <br /> 3200 Cedar Street <br /> Everett,WA 98201 425:-257-8810 <br /> Date 7[2!) 1 <br /> Shat U i 1 P(oelLY-FS, �•S 5)4Ai�-e.Tec 6 So vias , 1vtc. <br /> Owner Name: Applicant Name: �t' ' <br /> Mailing Address: 2-01(-)5 S- W;+�'0 J � Ae Mailing Address: 2.-0-73S $618\ARAN A'e <br /> Carsoh , CA ?° !° Coorsoh , (A C(07g6 <br /> Phone Number: q2 s- I I3 I I i,L! Phone Number: 3f0-B SS` ti LtS S <br /> ROLA-"K(142- ,9 re iir vid ir-cztkX (ruler l+or-lt 3 0E e�ctS t rt,i <br /> Description of Work: R J <br /> well . (JAW" ib) <br /> (A drawing or plans may be needed to illustrate work to be done) <br /> Site Address: l g I to I I Zt to SE i Evese-f-f- <br /> Comments from Inspector during initial inspection: <br /> Approved for issuance by: Date: <br />