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APPLICATION for <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 425-257-8810 <br />�i <br />�f� a`� ��.D� <br />�" <br />A����� � Date �/�T a�/aUC� <br />�'�R 0,(�'Ti ,_ � <br />Owner Name: �ti C�i/L(Sr, � I-k-�NRy qPPlicant Name: ��✓P=J��A-+�C�c7�5"ia� <br />Mailing Address: �a0 '�'I G/4'��k b�/� Mailing Address: S�MF <br />��T G+�- %�?a3 <br />PhoneNumber.C�aS� �65-��� Phone <br />Description of Work: <br />Site Address: <br />, � �� L �Gi� � <br />� (� c.� d�� �� <br />(��Ff�s'C— S`crc <br />�A drawing or plans may <br />��ar) ��e - � � <br />,�ao9 ��,R�,�x � � - c�cr-7> w.�. d' 03 <br />Comments from Inspecfor during initial inspectfon: <br />/� Ciry ,vEE�7s 7a l.clp,2/< <br />Q(.i%/12`�2 /S yLi�SPpri/5 � B LLr <br />�� ��-���� <br />/n/ �(�N7 �r�,.�'� �/l�O`52� <br />��2 ��-ec9V/n�G �"�� <br />t <br />Approved (or Issuance by: Date: <br />