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�t��: <br />��yi:i.;.'i, .EdteTv <br />. � ..:; <br />�•. <br />, > zrr <br />y`C„ y ' �.�� .�:�" <br />G`��.,YL�I �� <br />��()�`-�' a (� <br />Application for <br />Public Works Permit <br />Public Works Department <br />3200 Cedar Street <br />[verett, WA 98201 425-257-8810 <br />Date: (!� �n I I�— /��,7 <br />Ownar Name: ���N V pl�� � C�� Applicant Name: �9N �9�%%C� <br />Mailing Address: ��� /�IAl��S6N�''�`� rvlailing Address: �'��I /f'l9D/u�/V v �- <br />/� !T <br />�dr�,��vV�� 8Zo3 � ��rr�w. q 2�3 <br />Email Address: p 1�ID%�VIDGE�'�6�l�tpf-fmail Address: .LWDA�i����M�HGfO•� <br />phone Number. /��" �J�D- y3�j Phone Number: �I ¢/ S� �i3B�3 <br />Contac[ for Permit (Name/Phone/Email):_flYaN %�t�/G�'x � 9� .>N y�-� �ND4Y�DC-�L�'"�nlL ��� <br />Description cf Work: <br />'ACl/=/C 1�U <br />�C� �STP-�Il�tJb���?t�,�'fT D�-�`GO�II -C�',e�"�-> ��f/y/�_ '�__��i`. <br />(A drawing or plans may be necded to illustrate work ro be done) <br />f� I / <br />Site Address: J ��__ / -' <br />Comme is from Inspector dunng initial inspection: . <br />�iA� ��1°� ��S�ee�;c�r�ce�v,ue�,wlne� __ .. . _ . . . . _ .,- . <br />�;���.`d+� an���� �n�.\�.. '� i._1 � �' .,''�� � �`=' ��` `'- <br />� S 4i�21.�CSt , , y `. ' ; � <br />� �C.2QO��4CC� �1' i� � %'2 �' G . ., �_._ <br />�l�, '.ZS�•°�0`� ;�� � .`� i <br />�_' _ ; <br />. i , - �- -. �, �, <br />` Ci ' � U. �_ _ i <br />,:,,,r�:, ; . <br />. �_,.___....__... --' _ - <br />Approved for issuance by:�\1 VL�,_���Q�� Date: �:� �`V\� <br />V <br />