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�c�o 7c5 c 3� <br /> APPLICATION for <br /> PUBLIC WORKS PERMIT <br /> PUBLIC WORKS DEPARTMENT <br /> 3200 Cedar Street <br /> ' Everett, WA 98201 425-257-8810 <br /> Date � 1 � <br /> I� I � L�C / / <br /> OwnerName: S1�UG/t_(.�'ifP. �/rn-t�U�12�,AppltcantName: �oL' �E`tr,��'� <br /> Mailing Address: ��� �� ���h�.0%'9-�='�='2'Mailing Address: <br /> ` l/��1:-C�1 '+"' %c�21�1 SA;�:h.17� <br /> Phone Number. C�;j:� 7 � �•-- ���6'� Phone Number: <br /> Descriptton of Work: c�N�uz<� ���A'i��"'� I9'��-iiV 7 X' � S�W�/'-- /!�i'+%r� <br /> ��..,� � �7-rw <br /> A�� FI'..e;N��/�n/'��;J�%1�^�-,utS .4�N L / /r l� J� <br /> !�-N(1 Joo'� S-� SE. <br /> �P, drawing or plans may be needed to iliusirale work to be done) <br /> Site Address: <br /> GiU % '� L-%�/ �%QQ� �� � <br /> Comme�ts from Inspector during initlal inspection: <br /> Approved for issuance by: Date: <br />