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Owner Name: <br />Mailing Address: <br />APPLYCATION for <br />PUBLIC WORKS RERMIT <br />PUFtLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Evere�t, WA 98201 (47.50 257-8810 <br />�(,�o`et- �iunC� U'�(✓� `�Applicant Name: <br />�� �U 1� �G6iO �+ N1XRDiv.iMailing Address: <br />�ellev�� �, w/� �i 6c�0� <br />Date <br />��a�r,e B��bb <br />%_:�v,� aS <br />�.:.. O t.ti ��e v- <br />Phone Number. ��{-�S) /�(L 2-3�j� Phone Numbar. (�-ZS � 4.(p z- 3�CiQj <br />7: �" �•— 4^�4 - 3G o i <br />Descrfption of Work: <br />Rej�lace��-,ec�-f � <br />11 e �U <br />,� � a � <br />I ( a � �`�-, n -� <br />� <br />��' ;,t l c�-tT� V' S�' cc�1i c7� wh`I � 1�� e � v;�. , I e� ol- <br />drowing or <br />may be needed to illustrate work to be � <br />O�+ �ei p�p�� <br />< Dra�v� � � <br />Site Address: ��� � �5 �' �� U�' ��' �oS S A� ��� 3 5 A v�c° ti1 � <br />Comments hom Inspector during initfal tnspection: <br />A�proved for issuance by: Date: <br />