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� ( F�W �vo6-a�� <br /> ' APPLICATION for o <br /> PUBLIC WORKS PERMIT � % <br /> PUBLIC WORKS DEPARTMENT � <br /> 3200 Cedar Street <br /> Everett, WA 98201 425- 257-8810 <br /> Date X ' -/ -/� <br /> Owner Name: r i+uc�{ �U^�� K`clntii GfrtfiNAppltcaM Name: �{„�l G"c� �,�c�f <br /> Mailing Address: Mailing Address: 33C� C�ft 1 fAH 'C <br /> ��vt?'r Lf/,!�- <br /> PhoneNumber: �2j- �t--�J - S��I� PlioneNurnber: �/2j' 2>�l �l�/� <br /> DescripHon of Work: J��+K! <<n"t � �t✓�C ����1'(a�I .2 Co nc'�K�'ti _ �jac� f 1 �� <br /> Q�l Pu{� l. pp���,��; <br /> (A drawing or plans may be needed fo illusirafe work to be donej <br /> Site Address: /0/� �RCr I�I�C qc1(„ �vCrt�T Cc/✓� • <br /> Comments from Inspeclor during ini}ial inspection: <br /> , / // <br /> '""- `i` V "�i•J. � f��"�i '�:!/f 'i:'P D41." C/ ��/' �%�. 'lCC7 .��Y �.�/ p <br /> i <br /> �� �./� ` �� �f • 1.>y, 7�f'�lTC� �ir , , .._ ., . <br /> ^ � i L. <br /> I �� �, /f <br /> ._. f'���?i, C/'�/ r"': `• ^_� : <A(C:� :���C'!, :, C7 " �:I ?��/'�7C�� <br /> Approved for izsuance by: Date: <br />