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Owner Name <br />Mailing Address <br />APPLICAI'ION for <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 425 �.� 257-8810 <br />CC a (�c�ppplicant Name: <br />yo /1� a vv, s {�t7 c� ►�, . <br />,3z� — // fr�%�}�, S� Mailing Address: <br />� �. - . � �. i ; � . <br />—r l � �'�J <br />/' � � n ; <br />�� r����� �n �� � <br />—� `'fi �`'^���. <br />� µ�.. <br />, ; (r , '� , <br />Date L� �_ // <br />'• . : . <br />.. . %i� <br />. / �/� .. i <br />Phone Number: �12� -z�3-�r-��-� Phone Number: �aS _3�-�7��_ <br />�t1L� Cn,}���)�, � � <br />Description of Work: v 2 a,, o� J c ' a o%,�, <br />�, ,'LC��. 1�.����� uN;-� �� �i, �v, o <br />-� <br />S�, ati,�/ `,�.Q.�� �,ol u�" a' d�; l�l, i <br />(A drawing or plans may be needed to illustrate work to � <br />Site Address: �3C,t7 � � ��� �-y�. <br />Comments from Inspector during initial inspection: <br />�' p�� � ' fi,. <br />{ �: <br />Approved for issuance by: <br />�i �Z � - ,// <br />� �f'�� j$ !^ <br />��� � �, - �`` ,� . � � ��. i J%� ( i'"�:-` . . .Q11� <br />�ti :� �.��:3e� � ��� ^�!a'��"�,Pc,. ,� �� <br />� � <br />� �..f P / � .�,/�� � <br />Date: <br />done) <br />