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� � ��u �5�� - � 3 � <br /> Application for <br /> Public Works Permit <br /> �,r;,/� Public Works Department <br /> �'"'�`'� �' 3200 Cedar Street <br /> Everett, WA 98201 425-257-8810 <br /> Date: $-1 t�- LS <br /> Owner Name: Pp�^j- aF ��G� Applicant Name: Pa�1-o�' E��� <br /> Mailing Address: p.0. Q�x 53� Mailing Address: Sa.rre.p <br /> ��AP��.(.tJ19 98Z0.''o ~ <br /> Email Address: Email Address: " <br /> Phone Number: �ZS-ZS'�-3f(o�f Phone Number: �� <br /> Contact for Permit (Name/Phone/Email): �3r�� W{�.��.,��- (f�r�-r��i,��)•, <br /> �f25-3�-GYvr 3 • b�r-Jh.i'f�t.ke.-�o �r�f-afeue.rr�com <br /> D es c ri pt i o n of W o rk:7/z,i.c t,o Pfia.ae Z. e�C 'f�lE,e l9�-ts C�rt�a-� !►?a.r�.r,np�aU�nQ�"e �arr), <br /> 7��0�0?C'Ctuxll n�Ctt�p ac �) Len�-it.P.�-Ck�c�76T ltact,�eli�2f� e[2•�G.d.h PJQ[.D�i� e�d <br /> dzlc-s anol r�c�a�raac�m�.� �S'o--Fa�-�aQ .bu,C�cl�D� <br /> (A drawing or plans may be needed to illustrate work to be done) <br /> Site Address: [��Q.n ��f� -/loY'' S� �vrd u,��Ina��V���iue; md�'a� �, � �S <br /> Comments from Inspector during initial inspection: G�frriP lrta�uA <br /> Approved for issuance by: Date: <br /> 02/2013 <br />