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APPLICATION for <br /> PUBLIC WORKS PERMIT <br /> E1�E :TI` PUBLIC WORKS DEPARTMENT <br /> 3200 Cedar Street <br /> Everett, WA 95201 (425) 257-8810 <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> Date: 311212915 <br /> Bldg Permit tt: C1503-009 <br /> wnor. Mailing,address: Phone: <br /> TEMPERLY ROSA & BRIAN 2216 127TH PL SE 5035600509 <br /> EVERETT, WA, 98208 <br /> Contact: Contact E-Mail Address: Contact Prone: <br /> [ContactName] [ContactEmail] [ContactPhone] <br /> Description of Work: REMODE L-TEMPERLY'S LONG TERM CARE FAMILY HOME <br /> Site Address: 2216 127TH PL SE <br /> Legal Description: <br /> Comments from Reviewer: <br /> O <br /> :UnlurfTl N FORMATION � <br /> Meter Only ❑ Complete Service ❑ Install per building or per unit? (circle one) <br /> Size of water meter <br /> City of Everett Sewer: yes or no (circle one) <br /> Approved for Issuance by: _ Date: <br />