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Application for <br /> Public Works Permit <br /> s Public Works Department <br /> 3200 Cedar Street <br /> Everett, WA 98201 425-257-8810 <br /> ? Date: <br /> Owner Name: J�r�'✓/C' �/v 0 �'(/ / Applicant Name: [ 2 ei a./c/ <br /> Mailing Address: � -'7OGtfl Q/ Mailing Address: 97�P <br /> Email Address: �/ mail Address: 5 _ <br /> `` -�- <br /> Phone Number: /,,,I <br /> /.2 5 3 15 9 6 Phone Number: <br /> Contact for Permit (Name/Phone/Email): <br /> Description of Work: cdt Q1, a14-1!n �U C (Va' ( 7 e <br /> CIA.i(� � ��JM 5 �fu � _ til ,✓ d Q ���5�' �IQI� <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 />