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APPLICATION for <br />PUBLIC WORKS PERMIT <br />PUBLIC �VORKS DEPARTMEfVT <br />3200 Cedar Street. <br />Everett, WA 98201 425-7_57-8810 <br />Date �' �1' �� <br />OwnerName: l_,'.iQIVL ��ni��� ApplicontName: ��me <br />Mo;ling Address: rD �O� �p �� nnailing Address: �Glit'ti1,t <br />(k>E��tMrn.��PS6a- <br />Phone Number. �C�q �%� • C��r'j Phone Number. ��,M.� <br />_ [ � � / � <br />Description of Woric: �/1.0 �� W1Gl Gtem v i ✓�.J� Y�� �1 �'�' OG(iti-� <br />._.. -�— — <br />(A drawing or plons moy be needed to illustrole work to be done) <br />Site Address: a� �� I' ��G �(%1�lG�h.1�l�P <br />Comments Irom Inspector during initial inspeclion: <br />ScJll�18"' �Ii11J�?�{ <br />113�i �^,�t •'O 1�.11� <br />� 410"I L � ;,��;�;• jj` � <br />I r, ; -�` , � <br />�; , r, ;C1- <br />��� ��n��.� N�___ � <br />Approved for issuance by: <br />Date: <br />