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(�-dol iv •� I v� r e c�-ot �-�Y � i�w � i Or- 0 c( <br />APPLICATION for <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 425-Z57-8810 <br />Date �/�0 /� <br />Owner Name: �L � ' �1, � "�v �2�/� Applicant Name: �'Qv C� � • C�y� <br />Moiling Addre_ 3 ZU(> G(�'4YV S� Mailing Address: � 2U(� L�C.���� 5 j, <br />� , //�r. 2�'r��' Gr,� °I (r/ ?dl �l% r/I��'Tii�( �� i � '9 <br />, , <br />Phore N�mber: � 4Z5 � 7 5 J'� �1 � LJ <br />��� " l5 � fJ �� U Phone Number: <br />Description of Work: <br />Site Address: <br />v^, <br />l' <br />�✓ <br />i i 5=�1 S�� r%1�� ��` <br />, -- <br />/� f�prf.c=-�•n7 7�/�e WC1r,E Covc?�^e���� SEPA�9-O4/ </acrr. <br />— � <br />�� drawing or plans may be needed 10 illusfrale work fo be done) <br />S <br />�%2�iJ% 1,�,�- <br />� <br />Comments From Inspector during inifial inspection: <br />/7c�e� Ci f� S{�e�s <br />/�/Z7�i�e .5�� Tc�,,,l'e <br />�ilGCc�weN'�. �ro✓i� <br />Q$ /�C�Q UQ � <br />,�' Lec �, a � a �� �i:���,s <br />4%'OUr, q� i"n/!/C'�" S/�'� OT QG:"f� u70r�,� <br />�2 C'�� � OI��C' G�l�'US�Otn Cp�-r�rdc�. /o'l�SS U��'S <br />—� /�v�x- yCpr �h�r l.lJO�^� / CUzciQv� D/�IG�Q�Ci^G>J /vIUS{ 6G� <br />�,j / / t � .�/� <br />CYfSr�ci!!?CCO � �n �/J� ,�/PCSD � <br />Approved for issuance by: Date: <br />