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1 "� <br /> . . � O� <br /> ��O1o07-G2�'I <br /> APPLICATION for , ; ' <br /> ' Pll4LIC WORKS PERMIT � ^ ; h r,-. <br /> PUBLIC WORKS DEPARTMENT _i % ��r•'Z- �`� <br /> 3200 Cedar Street j �� � � <br /> Eyerett, WA 982�. (4250 257-8810 /' _ ,�I� :l -' <br /> (:I� <br /> � . .(�' '°�- <br /> � , <br /> �ate �f�9/n� <br /> �� <br /> Owner Name: Fa/'r" oG Ev�� �'i Applicant Name: f}O�F''`l�'n/ Gc�n1S1Jp���."� <br /> ��,�-+�R��'l <br /> Mailing Address: 7 �ll �v✓� ��-/�-�Mailing Address: /SO.� wEST�A�t.� A✓�L /�J <br /> _c►���zE��Y ,�v�r�gz�� ��rr�/.� w�' 9�ih9 <br /> Phone Number. l,L � �• � �� — 6�pS Phone Number: <br /> O/NSTALe� 'Z�3 �-f �" Pl/r SEG,��1E' AN� Z �j,gii <br /> Description of Work: , D��'�^''�T'r /y'�' `�� " � S <br /> � !N ST/,t.L z , . � r . c � �� <br /> .�t�r,�f��/'A2 y wAr�'� G.�.��� � <br /> /��!;� <br /> , � . � � i. � � ,�' <br /> (A drawing or plans may be needed to illustrate otk�o be done) ' . <br /> . , <br /> �:��� � �• <br /> � , <br /> Site Address: � U 5 -�`��-+ Sfr'�'� i � :"� <br /> i ' i <br /> Comments from Inspector during initial inspection: ��: � � <br /> Approved for tssuance by: Date: <br /> � <br />