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T"> I <br /> ` 4 <br /> Application for <br /> Public Works Permit <br /> Public Works Department <br /> 3200 Cedar Street <br /> Everett, WA 98201 425-257-8810 <br /> Date: <br /> Owner Name: 21i��I y' �����"��`'hPlpplicant Name: ��,.3 r ;Z_ KL, �1Eel�o�✓'c�ti <br /> Mailing Address: `z L/Lf AV Mailing Address: /�`�z/ — Y <br /> Email Address: 444 4r `�� .►�o " `mail Address: <br /> Com, <br /> Phone Number: Phone Number: <br /> Contact for Permit (Name/Phone/Email): ffa`"`"%` �Gy`/ ti ��a t�h q <br /> Description of Work: P" I- `I G S►— �� ���� L S <br /> (A drawing or plans may be needed to illustrate work to be done) <br /> Site Address: <br /> Comments from Inspector during initial inspection: <br /> Approved for issuance by: Date: <br />