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�#�,�T� ,T' <br />Appli�ation for <br />Public Works Perrnit <br />Public Works Department <br />3200 Cedar Street <br />Everett, WA 9$201 425-257-8810 <br />Date: � 4�Z�.� I ? � <br />Owner Name:C�A`�`i I.l�' ���N'` ��'�L=L�1�►pplicant Name: C'--�� I,l`?t:=� C 1�1� �L;, c..�►V Yj <br />Mailing Address: �5���' �!--�t �'-.�� �V Mailing Address: 'Z�='f.`� ��1 1�,�'1�� /��� <br />�-=. V ��'—C,T�T' _ LL°� `� �' �(L"'� �V �'��.I-=T��1" 1.L�11 � r;�:0 � <br />Email Address: ctA� ,����'6Y1C��'����i1al., Email Address: �Cu.�, i���?��-���Y1�;� ��:1C�►°v� �c����t.h,,, c. <br />�, � fYl c-�� , �-�� i-r� ` ` C.fi' ip <br />Phone Number: ��— ��r 12..?��-- Phone Number:�;�� -- �7 �- � •— � 2-�� <br />Contact for Permit (Name/Phone/Email); G�� �`l �.�^ CI' �L`�'^v � <br />Description of Work: �►=��'.,'►���'�' !� �C—.1�i�`�� _ �` �-X��C"[;.�b � ` I f.fit�>"-1�1-�� <br />'���� ���--�.-�= �� "�:� , Uv `��� 2-6� -�`t� I �-��- GO�Q���� (Z � <br />F� x� ��t-��_ �_.� F� �� p t�, �� �� 1 P-at=-l� ,�� , �-�` i �_L:. k�� �, �T- <br />'i_-.L�-\�� � � � � '' � �.C'� t�.t yt��:� l�-"D ��'�1�i711 i�� <br />(A drawing or plans may be needed to illustrate work to be done) <br />Site Address: � ��; � �� �,\ �-�'�� ;�� <br />Comments from Inspector during initial inspection: <br />Approved for issuance by: Date: <br />