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Owner Name: <br />Mailing Address <br />APPLICATION for <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 425 -� 257-8810 <br />,� <br />j\L%�� n 1 Lr' l.V �s��� \ 1�l'vl'� <br />^ it � �. � <br />. . C,', i� C,� -� � <br />Date �/�%� 3 <br />Applicant Name: �`v� } /�l � ��«- �'L <br />Mailing Address: ` ��� � ���'�/T"G� '✓�-�% <br />��� �j / � ( <br />/ /.�. ��.SL' i / /C- l.�;i/�� � �' � � !��' � t'� ��Ci i, Ci. %�\ (/L'� C���� �'Z <br />� � � <br />Phone Number:��v�5� ��'�1 '� 7� � Phone Number: ��.�5� �5 �%� �/ 3 I <br />Description of Work: <br />� <br />��"� ��nL -� c;,-J �,�.�� I � S1'G�� C; `.�-'����; <br />, <br />� ; �. � �� C�� � �L�� . <br />(A drawing or plans may be needed to illustrate work to be done) <br />.�j:� � `� <br />Site Address: _� \� � � � �.+�- V� � L,�;�:��.:� �ti /�- �� � � �: � <br />Comments from Inspector during initial inspection: <br />� <br />(o C ��a.� ,�._: ►� <br />� �=.�-h� <br />D4Y.� �.� �� C�..��J � . ;. � <br />�@ i <br />E !%�i`' � a� � �:! �nrJ <br />� � ~I �'!P L' (�" � �v 4� �' i {�'i � <br />-�-_�� E.?i"E'C;l�'4�4? ��;>;�; .,,_, ce _ �_.w <br />Approved for issuance by: Date: <br />