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APPLICATION for <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 425 • 257-8810 <br />No DC1 r0-ol z <br />1 Date 1013 <br />Owner Name: �ur Fko1l�l�ue✓San Applicant Name: �Ic'1/4i1I Igl�l4nSon <br />Mailing Address: 170 Y 4&A bo Y- Lo a _ Mailing Address: 14 7 DY h1 aAAx,- L&"_t <br />Phone Number: 425-Z(os -O-Syg_ Phone Number: yZs�-24.r-0Tg5Z' <br />Description of Work: <br />(A drawing or plans may be needed to illustrate work to be done) <br />Site Address: q <br />Comments from Inspector during initial inspection: <br />Approved for issuance by: <br />Date: <br />