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Application for <br />Public Works Permit <br />Public Works Department <br />3200 Cedar Street <br />Everett, WA 98201 425-257-8810 <br />Date: 0 t I!-� -L t'1 <br />Owner Name: Applicant Name: Q a'•r`' Uv�,,v <br />Mailing Address: 4C(-Q> 7-I-Ttt S-r- S 4 <br />-$6—K11C--v— WA7 't56�Z-9 <br />Mailing Address: Zti'rtc -- t' 3 �- <br />Email Address: -F> k i 1°'tAkL- "Email Address: �' <br />Phone Number: ql — � -?f Phone Number: 50'' , <br />Contact for Permit (Name/Phone/Email): <br />Description of Work: 7-- 0- Q"'DU <br />'Z-c)Z=®% d939 Lail= 2-13Z <br />/ 2-a7 - 2-06 % -- O 3 <br />z = Z/ 3 <br />(A drawing or plans ma be needed to illustrate work o be done) <br />Site Address: <br />Comments from Inspectorduringinitial ir�Kection: <br />Approved for issuance by: Date: <br />