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�,e . <br />.. � <br />���=��� '� <br />Application for <br />Public Works Permit <br />Public Works Department <br />3200 Cedar Street <br />Everett, WA 98201 425-257-8810 <br />Date: �� ( �� <br />Owner Name: �q�V �' `( o � �\c�, �(�%��pplicant Name: 1 �`Y1(;�.(_,�t `� �'�trUC,��`�l �J"� • <br />Mailing Address: `� I�� W�1,T r<��,Glc. r1U'C Mailing Address: �`� ��L'� ���12� <br />� J7 ±�t'r-r�'"'�' UVr,p, <br />Email Address: -Sb bq�ria.�� Co�`Pl <br />� � 11 C�u � �-- vJ �^� �. � � `� � <br />Email Address: � S`mc�e.iSri: i SMCtiZ�S � 1�LC:�CG'M <br />Phone Number: `_�`�� Z� ���,�---� ��� Phone Number� f � 2'� ) 7i� '"� �����--� <br />ContactforPermit(Name/Phone/Email): � � '� �('Zj i�-i�?Z2 jS�Y1C���=';S`�'```-{S'� ��.,,� <br />Description of Work: <br />��� <br />u� � � �� � �� � , .= �—�..�,u. ��—` : <br />(A drawing or plans may be needed to illustrate work to be done) <br />Site Address: � � I v � � 1� � ��'l� � � L�, '(.� �(�.�i�J�� U�J G� <br />Comments from Inspector during initial inspection: <br />Approved for issuance by: Date: <br />