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Pwlzo� -o� <br /> .;� : APPLICATION f�r <br /> PUBLIC WORKS PERMIT ��S o0 <br /> PUBLIC WORKS DEPARTMENT <br /> • ,Ev ETT 3200 Cedar Street <br /> .. .:: <br /> Fverett, WA 98201 425 • 157-8810 <br /> � <br /> Date f��L ��� � <br /> -� <br /> `-r-� i� <br /> �t'l ��J � ��1��� Appllcant Name: ° �,"�"-- <br /> Owner Name: �� - <br /> Mailing Address: ��7'� %� �L'v Mailiny �ddress: ,���/ �� �✓ �"`� <br /> �;�.,� /f w;r �az�� , y"„v� f w!4 f�'���, <br /> �� - <br /> Phone Number. � �-�� � �� Phone NumLer. (`fL y^ 3 S� . y �8 Z.. <br /> , <br /> /�D rt {'� H �r /i ,t ��� �a r< .�% 3 S ` �r.,�; <br /> Desctipflon of Work: ? <br /> � em�•zd iy �+=�L — <br /> , <br /> �A drawing or plans may bc needed to illushaie work to V�e dcre� <br /> Site Addtess: �� J L -��,,,�,t � /�dc `l.'r �� ,�1 l��i� `�',1�-� <br /> Commenls from Inspecior during Initial Inspection: � <br /> � / -7/ / lJltl. ! (.`I. J l. <br /> �' .�C�:. <-� �`( . � �1 � � � .C- � Lil. C . <br /> i - I <br /> � � /1 '� � / �C,z /i�lc S �t �[ � ( /SC1c,f `, <br /> � <br /> ., /ic_ LL'1. J�C . { � � ,. C � 1f/��� <br /> _� � l� o � <br /> � _ �• t <br /> . f � 1.� ( /! � � <br /> ��� i�l c- _ �- i i l � ) <br /> Approved for issuance by: _ Date: <br />