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���p�-eo� <br /> - APPLICATION for � <br /> PUBLIC WORKS PERMIT <br /> PUBLIC WORKS DEPARTMENT -, <br /> � 3200 CedarStreet �p�G7 "�°� <br /> Everett, WA 98201 (4250 257-8810 <br /> Date ,C''' l " �' �� <br /> Owner Name: <br /> ��r��•I7�r�� �, �.1:.,����i�� �- ��ppu�a�t ___l�c�� � . i �-� ���rv (� <br /> xNama: r <br /> MailingAddress ��C,�'("C' �-�t �`( ��i ��a�+V'MailingAddress. c_'G$'C`�� L.� ��� ����`' <br /> �T" J � <br /> �� �► �1�' 7z ,� Lj ,- I�n,; �,rt�. ya�l��� <br /> Phone Number. _��� �, S �- � ( � a� Fhone Number: � y 3s --J'� ��) <br /> DescrlpllonofWork: 1 r •� �c-� vF .l �-r,,� �� .� �� ��<� � ���c.-i <br /> (A drawing or plans may be needed to iiluslrate work to be done) I <br /> Slte Address: " ' I ) �' F'' < < — ` � '`�`�L <br /> Commenis from Inspector during Infllal inspection: <br /> Approved for Issuance by: Date: <br />