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�w 15D�-DD I <br /> _ APPLICATION for <br /> '`' RUBLIC iNO�iKS PERNlIT <br /> E� ETT PUBLIC WORKS DEPARTMENT <br /> ` - 3200 Cedar Street <br /> [;;.: <br /> Evere±t, WA 98201 425 • 757-8810 <br /> Date (�f/�ZO/S <br /> Owrer Name: A[tlCf[CQ ��St�Q1JJ�ApPlicant Plame: /��[tQS �FfrL��71'�7e� C <br /> �-� n <br /> MailingAddress: �/OS. F/'7L![ � S�_ !s:oilingAddress: Z�,$/Q �O�[.[�C�4/ /`"C�� <br /> —�— Rd <br /> �,�i/��z.Q2 uJoo�wau , wA ysp2� <br /> Phone Number, ��(�. �2�.�5•yoo Phone wumber. S/�S- 77`/-D/ 88 <br /> tantrzct �p,Lg i ' : f � .t - - <br /> ema� L ; ashLr�c � v'cr:tc,sdev.co7n f��.��x `t���s �o6- gi�-63S7 � <br /> Descriptic:i of Work: COPZZ�1+77UGZL�i 077 p -f f LJ / D / <br /> —� '���1_.3�Ze�� <br /> �,p��� 7�0% SC/S ?77L � S�Z[�CJ D/'�z[,c! '� <br /> .� <br /> {A rawing or plan�ay be needed to illusirate work to be done) � <br /> Si're Address: �(� �h �} ��en�e Cl�ES c, d" Se� �Q4 L3/v�� I <br /> Comments from Inspr_cfor during initial inspe��tion: I <br /> Approvad for issuanc� by: Date: <br />