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APPLICATION for <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTN� _NT <br />3200 Cedar Street <br />Everett, WA 98201 -�25-257-8810 <br />�, <br />Owner Name: � ����7 Applicant Name: <br />Mailiriy Addresr. ��� �• ���C..�i�r�y.� Mailing Address: <br />�!/��ri-ih �t l/lf, %�91� <br />Phone Number: �/Z i J'jy -7/f� Phone Number. <br />Description o( Work: <br />� <br />� � � <br />� <br />� � � 6 v�; - <br />� �8 <br />� <br />C= iit'2'�, � f�Zt'J l <br />yzs 3�� �v� �� <br />F <br />S��-lP L✓7,i/C �7i� �i��'S /t�'i�l OIC//�'n � I�k-P w <br />T <br />�A drawing or plans may be needed to ill�slrate work io be done) <br />/ <br />SiteAddresr. 2zzZ r-l�S��a-,� �vc Jt�Z� <br />Comment� hom Inspector during InHial inspection: ��� 8� 4� ��� <br />, <br />Q %y1/a.Y.� �Z" ,(��Gl�� Fi2er.vT �'�Zo Gr. `� � �,�c��a ¢ S�� <br />-.�1�-y.r•: .-:Cc,y i�,._ -�� � SrD[- /U <br />�� <br />��'19f � . <br />-� 1���:_- C�� .=c-c... /���c�S f� C,cS� �/:1 �il�c� 7lO�i�- /�vi�iCip�.l <br />�JLI/'�OSCci� ��9-'�'7 -��a:..' Clci7�:/ i�`��� ,�c' /:]S��'•�r�,%�c' 7ti- I^f/�iC1�4 � <br />/ � /� f. .r <br />.��� /"C(G/IS%l'L�[//C�7 O, 7/1:' � �_/7L�.. �6' <br />Approved for Issuance by: Date: <br />