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Application for <br />�f � '� Public Works Permit <br />,�, <br />��. ' � `�� <br />�.;� : Public Works Department <br />r���, � 3200 Cedar Street <br />'``- Everett, WA 98201 425-257-8810 <br />Date: � l S l � <br />� � <br />Owner Name:;�/� SC-�1����� Applicant Name: /�'�C ��:��GV�����'� <br />Mailing Address: � �� /IYp;Ne �lZ Mailing Address: �;.�`l ��r��� � � <br />L 1��� l/ 1 lel�✓� �'� a�J .i �1�2`7�J�-�� ��" �� C�� �G <br />Email Address: ��5 /Yl ��� c��� ��16-�Y<��'`Email Address: ��'�-�� ,S(� �'� J�l`�� (� C� <br />= u � <br />Phone Number: �ZS �� �' ���� Phone Number: �.� '�v�.��` f�c.�� <br />Contact for Permit (Name/Phone/Email): <br />Description of Work: �`i'��Cr� 1��++" <br />.�' � ' � -'�� � � - <br />� <br />(A drawing or plans may be needed to illustrate work to be done) <br />Site Address: �C�o�(v � �� [` /��'��-1-/��L C� �� L2� C�f� , � ���-�L �l ���� l <br />Comments from Inspector during initial inspection: <br />�����������a T� <br />� <br />h�i HY � � i 0 �i � � � <br />�� �� �v,��� r� , - v s,,;� <br />�..r,tl�:. �:�:,�„� ._;.� <br />Approved for issuance by: Date: <br />