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rj(s/0 - 0/0 <br /> APPLICATION for <br /> PUBLIC WORKS PERMIT <br /> �k>Y.: �, PUBLIC WORKS DEPARTMENT <br /> . ETT 3200 Cedar Street <br /> Everett, WA 98201 425.- 257-8810 <br /> (5OwnDate 7" © 1 zo(5- <br /> Owner <br /> er Name: Jovaa--L 4 I( ( Applicant Name: 30,4 4 4-4.`1,- (?-;t <br /> Mailing Address: /2-0 Z, /Y ,Or re- Mailing Address: <br /> w•t/A- <br /> Phone Number: y z5- - " t z-SY2 3 Phone Number: <br /> O ,., iv /0"DP°5es -to ,Vtovc. q3 ,1 of Vis,,�.,� (`,-41fe(a.1 fiL <br /> Description of Work: 5.cic.aw((c 40 $ fl?! fovlh, e <br /> C 2 \ Cone, ckkmlk.• 46144 ,a'(( Ko €xc•eedee.,(- '/ <br /> alovi,cU o,' (. %1;5 .P/. ;S oK 1-1..t 64ck �0,A-0.s +f ,6 tto, ( <br /> c k. (l s Or IC Rr.a ;5 1:41(--)14" <br /> (A drawing or plans may be needed to illustrate work to be done) <br /> C5:ec A. 4-4C GCOC rot-4'e a-te O�✓a ! w�, <br /> Site Address: I Z'p28 /y ` p'' 5C Evev "if voq y <br /> Comments from Inspector during initial inspection: <br /> Approved for issuance by: Date: <br />