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��N � �oy- c�l � <br /> Application for <br /> � � <br /> Public Works Permit <br /> � .�, Public Works Department <br /> 3200 Cedar Street <br /> �' � Everett, WA 98201 425-257-8810 <br /> Date: "1 � �� <br /> Owner Name•. /��� ���� APPlicant Name: S.v.-.�� �S nc���>f� <br /> � t,�l. Mailin Address: <br /> Mailing Address: 5733 "lD � • g <br /> �„o2e%%'ri/� 98��'3 <br /> [mail Address: J�/Q LE2�c�R ��o.�cAs%,vei Email Address: <br /> Phone Number: y2S-3S�-�pS"� Phone Number: <br /> Contact for Permit (Name/Phone/Email): 1\�� <br /> DescriptionofbVork:'"j�7/� ou!�-'u�s`i^'% s��� F G�A`/� o� %�� oc.�iL..✓cc� <br /> r <br /> SN / —T <br /> t�/�'N /� :%�o /1 F f .�,�Sf! C�x�afe�C1�.�C-�i fJ�//;v.a.✓_ <br /> �A.,.��c A/JL/A �e%�.t/cC�i✓ Co..�cG�B./ i�l,✓�� /�Loc% �.'co��'��s' L:�� '� , <br /> (A drawing or plans may be needed to illustrate work to be done) � <br /> Site Address S T 33 � /O � /�r� u/ Eue/�e �,✓�`�d�oJ3 _-- — <br /> Comments from Inspector during mrtial inspection. <br /> --I�1G�C�� �� ��� <br /> 1� �� <br /> i 2014 � <br /> L APR _ 1 <br /> C�Perm t Servi ces 7 <br /> tlpprovedforissuance by: Date: <br />