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� <br />�> � � <br />��,��y. �t�� <br />�' {� <br />��� <br />.. �,� <br />����D�' �D`� <br />Application for <br />Public Works Permit <br />Public Works Department <br />3200 Cedar Street <br />Everett, WA 98201 425-257-8810 <br />��-�a o��X�a�� <br />Date: �C�'.� I.�' -� � i Fj <br />Owner Name: ��_ J� ���"�-I� �.-�--'�=-i � "��--' Applicant Name: __ ��t-� �� � �� • n� <br />Mailing Address: � 1 " '� ��� �= `�'C ���'i�Vlailing Address: ���=� � <br />�`'�'�-�i , �%f�1 �--'! ���� _� <br />Email Address: ��%'�-�-r�e� ��-���"C'�-�-' I-�.�c�ail Address: <br />. � <br />Phone Number: � ��'- -��-'J � � `-�� �� Phone Number: <br />Contactfor Permit (Name/Phone/Email): --��" �� � '���_: ;�,-� � �� 't-r'- �-:�u,''�'�4�� <br />�� <br />Description of Work: ���US� � y �'-�'' � �; '� t' ('''t�r►�2 ��-i N �, �=sp`jr'"�t'� � i `.� <br />�CCSTiN� h"i°� �'Sc /�r c�.�c ii, C��,� Ll�n ��t�C' �`rS.. f �r��;� � �G :, ��9�1��' <br />L�: f'�F'=� vu � i "! . ��� L - N�- c« <br />F'%`siZ-(G!/,1(�. S�st'(,_ <br />(A drawing or plans may be needed to illustrate work to be done) <br />' �{ � � �,��_� =� <br />Srte Address: � I � � _ I -� <�'�:%�+�.0 �!--; �,� �' � � C' � , �..c) <br />Comments from Inspector during initial inspection: <br />Approved for issuance by: Date: <br />