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2 <br /> APPLICATION for <br /> PUBLIC WORKS PERMIT <br /> 477 PUBLIC WORKS DEPARTMENT <br /> 3200 Cedar Street <br /> Everett, WA 98201 (425) 257-8810 <br /> PUBLIC WORKS PERMIT REQUIRED? IV4 J_ Z' /S <br /> Date: 9/18/2015 <br /> Bldg Permit #: C1509-005 <br /> al, t 61 Sm _10,39� <br /> Owner: Mailing Address: Phone: <br /> LAGO DE PLATA VILLA LLC 620 112TH ST SE <br /> EVERETT, WA, 98208-8031 <br /> Contact: Contact E-Mail Address: Contact Phone: <br /> [ContactName] [ContactEmail] [ContactPhone] <br /> Description of Work: REPLACE EXTG MOBILE HOME IN PARK-LAGO DEPLATA VILLA <br /> Site Address: 620 112TH ST SE SPACE 100 <br /> Legal Description: _ <br /> rie�crCkeck- <br /> Comments from Reviewer: <br /> UTILITY INFORMATION <br /> Meter Only ❑ Complete Service ❑ Install per building or per unit? (circle one) <br /> Size of water meter <br /> City of Everett Sewer: yes or no (circle one) <br /> Approved for Issuance by: Date: <br /> J j� <br />