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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 Narne: Applicant Name: IIY7Z---7Ff (eoaF/N6 GL c— <br /> Mailing Address: 31101 CEP4R-s Mailing Address: 73e/ Go t pe Aw(.a/,fin,RO <br /> vz -�-s ccf/�. dao i GYNDc- /cv , 2�/� <br /> Email Address: Email Address: r ossa ��uh ro� 'ny . corh <br /> 1 <br /> Phone Number: Phone Number: 36° —JS`/-Y3-Contact for for Permit (Name/Phone/Email): Of tJ6-Ross /56 o—F/S--5 q6 / <br /> Description of Work: Cft9 MA'T"C.S ate- 7,11 OMRMIIZ he3 <br /> (A drawing or plans may be needed to illustrate work to be done) <br /> Site Address: X7/0 OJE7/H6)K- llv �—:vaeE77", %',26/ <br /> Comments from Inspector during initial inspection: <br /> Approved for issuance by: Date: <br /> 2 w he, <br /> z5 -7"S'4 -3S f3 <br />