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Owner Name <br />Mailing Address <br />Phone Number: <br />APPLICATION for <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 425 -- 257-8810 <br />1''l� S�,ruihcr.s t Svsah 4laaQ.riv <br />39i3 w. �t�k,l�,� �Iv�. <br />�vrx't,�,i , Vd� `i�20 3 <br />q25.5t4.�qQq <br />Description of Work: <br />Applicant Name <br />Mailing Address: <br />Phone Number: <br />� <br />� ��� <br />� �J <br />���� �� �/� " �' � C� <br />�ate I1 /Z 5 /200� <br />�ason IC;�� D�s�an + Landsc.a� <br />Sts l4'� Avc. E �3�4 <br />, ., <br />. �� „ . <br />ZOL. $Irl• 2�b0 <br />�?.+l►'�W2 2Kt5�11101 dr�v�wav'. �L^'DoVr Y1LW Gor�G(i'.� dfNLv�la V iY1 <br />S�WIL �OC, rlL10i1 f1�(1 � �� X��� �Xtfa Paf�ihA SwaGQ. oYl J W C et YtLf <br />o� dt'ivr.wa� . <br />(A drawing r plans may be needed to illustrate work to be done) <br />Site Address: 3q13 W. Muki��c,o �lvci. �v�t�i� W� ��203 <br />Comments from Inspector during initial inspection: �Q � Z— "�j---f�� �EyL ��-���E� <br />��� -,�,� <br />Approved for issuance by: Date: <br />