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� f <br />�F,,a <br />_/��`�,:,a i. � ,� ���, <br />Owner Name: e G�V1 �I 'G <br />Mailing Address: -] O (p � � n`�� S� <br />( �� r� �� . 1n�'I-1 � ��� <br />Email Address: ��� �� YY'�i <br />, � _� <br />Phone Number: :� �!�/ �-'� � U �- � � (� � <br />Application for <br />Public Works Permit <br />Public Works Department <br />3200 Cedar Street <br />Everett, WA 98201 425-257-8810 <br />Date: l� � S <br />Applicant Name: � �� � � S� <C <br />Mailing Address: �)(o ?7 � `�� �I <br />� ve �'e f-� . ��, l� `���-� ( <br />� �, � � �. <br />� Email Address: 'C r < ��-' �' '��c i� <br />Phone Number: �U —5 I � �� � %D �� <br />�9 I^ <br />Contact for Permit (Name/Phone/Email): 1 �I ��'�G's ►�J � j S j ��i _ � t� � � l0 �� �J'L <br />� YYI�c��n � I S)r�� °� YYIG�i �,<nn <br />Description of Work <br />(A drawing or plans may be needed to illustrate work to be done) <br />Site Address: ��(r'j �� n��l J/ f �C� <br />Comments from Inspector during initial inspection: <br />Approved for issuance by: <br />. ��rVl <br />