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Pw i �fo3- oo� <br /> ,� Application for <br /> Public Works Permit <br /> ' Public Works Department <br /> 3200 Cedar Street <br /> - Everett, WA 98201 4�5•257-8810 <br /> Date:J! �Z"� '1 <br /> Owner Name: 1"K.�7�Y� i�1�T�1E� [ [71Vh Applicant Name: �.A� 1 ��� <br /> Mailing Address;S�2Z g��� tiC Mailing Add� <br /> �`rav�v d�e ,�� ,,�Z�o <br /> Email Address•���1QaC�t�it7�ti'2rS,l0�h Email Add�res� <br /> Phone Number:�GJ'Z�'Zy 2.9 Phon�� e�P umber: <br /> Contact for Permit (Name/Phone/Email): ��� � N�I�IC� <br /> ZS •2�td- ZyLy �c�elcalnactckl0/�a�hPrs, cvr� <br /> DescriptionofWork: �+e� S� <br /> (A drawing or plans may be needed to illustrate work to be done) <br /> Site Address: �'l t7{ � '�i �"�m e�7rCe'� <br /> Comments from Inspector during initial inspection: <br /> � � <br /> S <br /> 8 <br /> � <br /> �� _ � .�,��� <br /> 3�rm d ,� �,-+q�2��--�'��v►� <br /> Approved for issuance by: Date: <br />