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pavw 150(92 - IA2" <br /> Application for <br /> Public Works Permit <br /> ^j kx Public Works Department <br /> ,b-vgfteerr 3200 Cedar Street <br /> Everett, WA 98201 425-257-8810 <br /> Date: 5/ e7/22)/C <br /> L �1�c / ice Applicant Owner Name: ��`7 �� a ab °u � Name: �'CS s � <br /> Mailing Address: 4/0/Z, f a-y- �� -2:- Mailing Address: S e�°x ,i—z'r4i te-49 f2#tr <br /> 1// C/ ./� x,00 j)?®/ <br /> Email Address: /Pse, `v A/oe', Email Address: S:eis., <br /> klA <br /> Phone Number: 4/0 s- -,1/7 Y7/6 Phone Number: <br /> Contact for Permit(Name/Phone/Email): /Q ��- 42.- 4,a. ct, ' <br /> crdo, StJeu,0I /" � <br /> Description of Work: - � �b L .� /.a,��aetti (, -r <br /> -lam +'/ F P./\/-A,- iee6c v �r ® /i'- �' '`-.to Cv/ <br /> S`d(z.o 4oc�C �v / s y �r�'t gbh /gip, <br /> (A drawing or plans may be needed to illustrate work to be done) <br /> Site Address: .�6'/9 <br /> Comments from Inspector during initial inspection: • <br /> I f <br /> Approved for issuance by: Date: <br /> ® 2-6—_ 317 _ 3) 2 v <br />