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� ' APPLICATION for <br /> PUBLIC WORKS PERMIT <br /> PUBLIC WORKS DEPARTMENT <br /> � 320� �edar Street <br /> Everett, WA 9830i 425- 257-8810 <br /> P� ��� - 63 � <br /> Date <br /> �r ' KQ � �� /' <br /> Owner Name: ���0 1/1 ��'� /)�2 .S r� Applicant Name: /�� ���`��3 �r �' <br /> Mailing Address: ��3 a C°r b�^ J 1z- Moiling Address: _ <br /> �vPYz �f tilA 9�a0y �nll G � �sky <br /> Phone Number. y j j� � ] I — I �y �)� Phone Number:� ��z't G � Z� y �d - 5�( J � <br /> I I <br /> Descripfion of Work: ��u-} � r. � -� � C �� ���Y-1' I h C��� L� 1.I <c r c�. - �t c r o� � <br /> � <br /> IchC;�'l, c) � �J0.c� ��::�r �l - 7� ' - ' „a_� _ , 'v: <br /> �- <br /> O ' <br /> ,n (A drawing or plans may be needed 10 iliustraie work to t�e done) <br /> U._J�.eA .$�2c� � SOD�-Q kJL� h �Zt�,�SO�l �� S / � . <br /> 1�Gh/ O..c! �✓/Th` /�/ST/n'lf�T1G✓✓ <br /> , , •—� � �� <br /> (l ry' , i� � <br /> Sita Address: U '�� ��f �% h ��� . <br /> Comments from Inspector during initial fnspeciion: <br /> Approved for issuance by: __ Date: <br />