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� � �,�.. <br />�•� y, a�� � .� <br />M � �'�a <br />Owner Name: � � • � ' �� � n � �- <br />1 <br />Mailing Address: � S e S ���-«��-�� ��,.' <br />r` <br />�L-� ( �� �'�� �� �! � �� � <br />Email Address: <br />Phone Number: �� ZS� 'Z`'� �- 5 So � <br />Application for <br />Public Works Permit <br />Public Works Department <br />3200 Cedar Street <br />Everett, WA 98201 425-257-8810 <br />Date: � ��� r� �� <br />t <br />Applicant Name: %�.� �<�C� ��� <br />Mailing Address: S��S I'� f V"l� � f�,�E <br />/' j�� ��iS = � ��Z �.�,��i �� � � � <br />Email Address: ,-n� �;,ns-�;-�;`f' ,�� (1 �C��-�,<: <br />Phone Number:�'��-�� 3 3 J-���-�-- <br />Contact for Permit (Name/Phone/Email): i%J,,-� �c �c ��r�, .-� l� Z� � 3 3=� ' C: JZ 2 <br />Description of Work: K� � � ;�:.�� <br />� 7� . !.\ ` ' `'> 7 ��,� � � , �� \ � � C <br />C- �C A ��- , n � � ; ,� � i ? C �,� (�tr� '� c;,j� , ; ry� � n ;�-�- <br />- ��..,� , <br />� ��� � :'� � ��� 1•D!� !n I � ��a � � � � �'� <br />(A drawing or plans may be needed to illustrate work to be done) <br />Site Address: - 5 � �� •� � � �' ��� �� ����i <br />� ���� L��. <br />Comments from Inspector during initial inspecti�'n: <br />���r:a � --r,�, i n \�`� �� <br />� !� �s � L L� L� <br />� �� � ��' ct�� c��F:=�� i � <br />� 4�ta��6��^;� ;��t��,����;;:� <br />Approved for issuance by: --����-�� .�•-�--r:..---�---�---� <br />�:, r'� <br />