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� <br />�iaE <br />y . <br />m <br />�� �.�`�� :� <br />� <br />QW� 1508-00� <br />�ss�n � ,�o�b�e� <br />App(ication for <br />Pubiic Works Fermit <br />Public Works Department <br />3200 Cedar Str�et <br />Evereti, WA 9$201 425-257-8810 <br />Date: `77 ` � l � <br />� �/ C <br />Owner Name: ^ �� ��� � '�-- l`���5 Applicant Name: �' �-�j � �)� �`' � <br />Mailing Address: �� J�„ I��- �� � Mailing Address: <br />��� �'� �� � C�� �� C �� � � L`�-�'�"'`'� <br />Email Address:�R`� �`� ,�Lu'' � ��mail Address: <br />� � � `� �..�-L <br />Phone Number:� �� ��� � f�'� Phone Number: � � <br />Contact for Permit (Name/Phone/Email): <br />Description of Work: ��' ��� <br />��� <br />(A drawing or plans may be needed to illustrate work io be dona) <br />Site Address: - <br />�fi� <br />--„ - <br />Comments from Inspector during initial inspection: <br />Approved for issuance by: Date: <br />