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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 />Owner Name: 4} rx &41„ I /ii1) G <br />Mailing Address: <br />6 -3 -io <br />P10)0016, 0.1 q1 <br />10, <br />i% <br />Date 5 -Z8 - I0 <br />AWL eFt G <br />ApplicantNamii(u Lezk R -Vi ,)c� nr% <br />MollingAddress: (a't) VA VCSCt rfL S} Sirvww <br />Stun WA 610 <br />Phone Number: 4013 - 3 5(, k�4t Phone Number: / /k �j2 £j •• (j <br />Description of Work: <br />J-&IZ Z- r? F : )e PAi 44 a4i "T 79 N 6, = 3d AA( <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 />k%4 <br />—C l7', S ;-,-�-X Lin¢ 6 /z, G' <br />tf LC4H aT 2LC fiincti <br />P2voirrant / aCiinC .SIaL ,> C/ohe 12v •J7�LC,/, #3/P <br />/rend' Si'c>rm" �s/ialC �¢ 6aC a" �^ Ci �ii S%a�',a 6/0 <br />—•� Ce�sc v5r� ���- c�S�'ecr;o./Pr�" �.�e•T LL,.,Lw;IL <br />re Uir�2 CO70 A 7`/e 60� ? 7* �res,('A/Te �rCdCh/ <br />CN n/� 4���iv:, ��Gt/a7¢✓` QGiJ� 7�%�' /i^�'.,Ci Le/�-� Kj <br />Approved for Issuance by: Date: <br />