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APPLICATION for <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />F.verett, WA 98201 425- 257-8810 <br />Date l /7:7 %) Z <br />Owner Name: N6W on K: Uk � L L Applicant Name: �l n�n'��/�on fug fifty r� <br />Mailing Address: EL D 32,1 d St Mailing Address: <br />Phone Number: �25 �S`�-J�/�fo Phone Number: 2—3L/�j—�f O SS <br />Description of Work: \L-0- 0 q V/f- t-, nc-f L, A"r - i'e 0/16y� t r <br />��le�se Con�� aPpL(�tn�- ��lh QI�C�l7d��� <br />(A drawing or plans may be needed to illustrate work to be done) <br />Site Address: � Z o <br />Comments from In_;pector during initial inspection: <br />re�1+ <br />�toI <br />�� <br />01 7 2 � <br />SEP � 2 <br />Ci T Y Or c^1tFit"fT I i Q{ S �Q!! <br />_W'ermit Services <br />Approved for issuance by: Date: <br />