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�� <br />�� � r <br />r <br />L-.. � <br />C�. <br />Application for <br />Public Works Permit <br />Public Works Department <br />3200 Cedar Streec <br />Everett, WA 98201 425-257-8810 <br />Date: `�-//� �� <br />Owner Name: �� ✓� �> > �� ��Uv� Applicant Name: �iS-,�c �! /�Q zc� <br />�-r.�.,,ld�ru� ,v�/w��,� <br />Mailing Address: 4// ' 33r� S� . Mailing Address: � 11— 33r�- '.�l <br />�/�r� (aJR �529� <br />Email Address: ��ON\e-tul� � (� I�n.Sn�['On�1 <br />Phone Number. `��S aS.Z !n/Gr(�_ <br />�� eh,�[ 1,L1 � �i 5�� / <br />Email Address� }���-�-_ �_ <br />Phone Number: — ba�^^� ' <br />Contact for Permit (R�ame/Phone/Email): (//i��%� � �%U�l�Cc� <br />Description of Work: <br />f <br />' �i� �-v�w CLr� � <br />d00 �� ' <br />(A drawing or plans may be needed to illustrate work ro be done) G�� l�R ck ,� <br />site Address: n �� ` 3� <br />�S� <br />Comments from Inspector during initial inspection: <br />APR � 1 7013 <br />Apnroved for issuance by: I" — <br />' C17'! Or= �VE�?E�f i <br />� Pei rnit Servic�s <br />��P� G�/ff �'s �' ' <br />Da[e: <br />r� <br />