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� <br />��d��i1" <br />�1 <br />Owner Name: C'��� -�� ��l.;n��►�►�c� <br />MailingAddress: 3ZZ 75 S�M� �� S�J <br />�'� �� ��- � �� 1 � z-� �3 <br />Email Address: �C-F+� I'1��u5�� <br />Phone Number: �Z��v• �� I �-j ( ��, <br />�► P� isQ�-oyg <br />-� l�1�,s �ii�o I�om� Q&r'mf���� <br />e��a�• a��r��h,�d <br />Applieafion �ror <br />Public Works Perrv�it <br />Public Works Department <br />3200 Cedar Street <br />Everett, WA 98201 425-257-8810 <br />Date: � l � '� l <br />Applicant Name: SR,111� <br />Mailing Address: <br />Email Address: <br />Phone Number: <br />Contact for Permit (Rlame/Phone/Email): �O�X�F <br />Description of Work: �����GiC+n C� �'r�t• ��i�,�� <br />(A drawing or plans may be needed to illustrate work to be done) <br />Site Address: <br />ha `�l � � � <br />� v c.� <br />Comments from Inspector during initial inspection: <br />Approved for issuance by: Date: <br />Z <br />