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pvV 121 I — Oc��- <br /> APPLICATION for <br /> PUBLIC WORKS PERMIT <br /> PUBLIC WORKS DEPARTMENT <br /> � 3200 Cedar Street <br /> �' Everett, WA 98201 425-257-8810 <br /> Date ���� ` / Z- <br /> Owner Name: �'u ,�Cr t�L/.�.�/�'.� Appllcnnt Name: ��F c i;; r i?yit.��,� <br /> Mailing Add,ess: �(o/ , �,�K-ti4' �� Mailing Address: � �/ G 5��-�-Y' /�1.'� <br /> ���,=,�,i, wn y4 ��i �,v�,�.r�c.,�+ ys • <br /> Phone Number: y� i", -�C•; Li �3�/ Phone Number: G/� S __��� - L�_jy <br /> Description oF Work: �'G r�Hu' .3`f S S 4• 1� T (� �' � i/'/ .S i /�c w�� x L'� E' <br /> /1�'f'G/ �'JSL�, c;c.i��.s 17 .! lz: C./'/�L rr� /1,�•t�i*�1�SS'/.vc= <br /> ��Et�S u� t� n(: w9Llc lh/ �L'Uit.T UF' /7'<J(.�f� <br /> (A drawing or plans may be needed o iliusirafe work 10 bo done� <br /> SlteAddress: Z �• / ` �''�'=E�' �i�k.e'J,.Tl; /•�/1 73?��i <br /> Comments from Inspec}or during initlal Inspection: <br /> � /d '; ��,���� /�c�� C� � �fc� ��� � <br /> �Z�� <br /> Approved forissuance by: . Date: <br />