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•,�;; . APPLICATION for <br /> �' PUBLIC WORKS PERMIT � <br /> FUBLIC WORKS DEPARTMENT . ovJ <br /> �Ev ETT 3200 Cedar Street �� � I � � <br /> v,r' <br /> Everett, WA 98201 425-257-8810 <br /> Date � �✓ 3 . �V�' � � <br /> -( LL c'. „Jr v`A ^� �'�-J <br /> OwnerName: � �`" �` �G` ��1`'`'� �``1�PPIIcantName: � <br /> Mailing Address: ZS U S ( ( '�f�'��� Mailing Address: 3 �"c� �n c jz�'1— �"�"` <br /> �tilrC 11 WGI �JZL7l� c ✓�C/Le f / � W� 1~Ci LUI <br /> � <br /> Phor.e Number. �-- Phone Number. �`I��-� ) 2s7 i�3�-% <br /> Description of Work: �p ��v � o � "��'�RE C p/}-'-�`i'`� -f�J''���f� F��' � 4^'1�v.r F CH/TTC`� <br /> '=n-c,nn wCLrAF-��foc . S�/Lvl� r-r �jl� 12�'Jc��� GSFhf�c <br /> A1r1� a�T ('o-vr��4 H-r ��c �rtitirc, 4'2'►,��'Z A.-i'-.�'F <br /> /�rrc�ir-�(�z�Ly � zSu .f ,L �� ��F-r�r-t �3�--s , �..� , <br /> (A drawing or plans may be needed to illustrate work 10 be done► <br /> Site Address: �� 2 Z � '"` "��`—�' �-�"'t''`' - <br /> Commenfs from Inspector during initfal inspectton: !� ��,�Zg� � <br /> � ��/7G �Y,Ct i5 rt$uilG� '{� b.0 �l rr�f� ���fi�i��nf. � 9'�'' <br /> SC.�CdGtl-C (l+i1d�CA� in�pGUfiin • �7Fi�*'tTiPrlZ, P�Nr'N/N� l�� <br /> Approved (or issuance by: � Date: � I — I����1 <br />