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� � Pw /�08' -Da� <br /> -- -------- <br /> -� i Application for <br /> :.,;•:. <br /> ��` Public Works Permi4 <br /> . <br /> _t,_• ' :r • Public Works DeparUnent <br /> , /�=7'iG=�C�t?��J � 3700 Cedar Street I <br /> ��;rt <br /> [vcrett, bVA 98Z01 A25-257-8810 <br /> - J <br /> Datc: � � <br /> Owner PJame: �Fc�r e}f In�P1��r,. • t.a. i�e Applicant Name: ` � S , __C��,,tpa , <br /> 5���:c r 5 � <br /> hlailing Address: I Sm(� ���r�r S� S� Mailing Address: �3�� 5 ��"e S� _ <br /> ' �� �� . �.. S2N i�,��,� �„ia q�qo� <br /> [mail Address: Email Address:�i.�;o r ��ou,.�e� <br /> Phone Number. 36c�- �3 I- 33 S C� Phone Number: �S3— Y�,� -yy�9 <br /> Contact fer Permit(Name/Phone/Cmaii):� � � ,�.� �3- la- ?$( pYwra,r(�t�M1��yfC�'>'�Nc� <br /> OescriptionofWork: 1"i � �_�u�����rr_$ a�-�Pr- �jc_j�� `� �nd �rY� I1��i�Q,1 <br /> �1 <br /> ��,�k v�on �y> + �No� �v o� �a�s�1 �, �I�n, <br /> �.,s�- <br /> c � �lu�a ��J <br /> (i>drawing or plans may bc needed to illustrate�vork ro 6e donn) � � _ <br /> ., ,; . ��;uutUng <br /> Site Address:_�Qm��O_w_e�__� ^f-�r_��_}��1�1C!_:�' � -�- f��`� �-- <br /> �--��-�- �. <br /> Conu ients from Inspeclor during initial inspection: % <br /> �, �/ zqd <br /> �Z '� <br /> l <br /> `,��2�.� <br /> Approved for issuance by: Date: <br />