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�'i��, • <br />r`� <br />OwnerName: ,� G�. <br />Mailing Address: <br />Email Address: <br />Phone Number: <br />(��1 ( �p�f -D�� <br />Application for <br />Public Works Permit <br />Public Works Department <br />3200 Cedar Street <br />Everett, WA 98201 425•257-8810 <br />Date: � /"7— /�-/ <br />Applicant Name: �,r/A\ i�iFD�f► <br />MailingAddress: .��,_�X �%OS <br />SZA�JE�DALt WA 71�OS j <br />Emaii Address: �_�e71A t���E Co�Js � �N� �'�,J <br />CJ u-� <br />Plione Number f�oG� .s �o- �i�/6 <br />Contact for Permit (Name/Phone/Email►: �/..IAD M�p�A <br />DcscriptionofWork: 51i�r SG�.JGi2 �[�i JT Oi— �'d�J�JFcik�•J <br />(A drawing or plans may be needed to illustrate work to be done) <br />Site Addresr. 9v � � I�jnAL>��R-`-� _ _ <br />Comments from Inspectorduring initial inspection: <br />Approved (or issuance by: <br />Date: <br />