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<br />Owner Name: cL�!/�c,� , �,�
<br />Mailing Address: s - '
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<br />Application for
<br />Public Works Permit
<br />Public Works Department
<br />3200 Cedar Street
<br />Everett, WA 98201 425-257-8810
<br />Date:
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<br />Applicant Name: t�i�,^J_ ` '� �i
<br />MailingAddress: S/-�-d��E'�
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<br />Email Address: d�%�X! Z�oL�( �i�'Lf� tt'�,'�.Y�mail Address:
<br />Phone Number: Y,�,�— ��.r- !'�/'��� Phone Number: �f �.�7 -".,,��% G����
<br />Contact for Permit (Name/Phone/Email): �'��,��_ l ���Y ��,�/�'��,'7`
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<br />Description of Work:
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<br />(A drawing or plans may be needed to illustrate work to be done)
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<br />Site Address: � �� � � ('_a ��'�/��i ,�' � Zr. LJ�Ic �� / �(1,1� ��,��' /
<br />Comments from Inspector during initial inspection:
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<br />Approved for issuance by: f ;�;���' :.
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