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elp.----- _ II UC '� ,'4" ;*.KS PEW,, IIT 11PPUUC TION <br /> zsz- <br /> CITY OF EVERETT PERMIT SERVICES <br /> 'r 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: —1.0--,: <t' v---) �- �T— (too �� s � � oJ <br /> � <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? 0 NO 0 YES, FROM TO - <br /> NEW WATER!SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE <br /> SITE WORK'/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: �-�67-- 1 4 >/L Civ Z N <`1. L.) /'-"1--) o,A.) <br /> Ste\LS `'-- *-gLS - eLA (.__;a-' ), <br /> ❑ FENCE IN ROW FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> 0 ASPHALT/CONCRETE PAVING SF <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT �4,,,,,kL --C-e:, ; <br /> ❑ CLEARING/GRADING/FILL/EXCAVATE CY <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF YVIA- t -EV.j <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) <br /> LF Cc,4-w 3.M-)'� ji • e o 4,1 <br /> CONTACT INFORMATION <br /> OWNER NAME: , ( r7w( r- 1. <br /> OWNER MAILING ADDRESS: STREET <br /> CIN STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> APPLICANT NAME: 2U ��/''2 ( � <br /> APPLICANT MAILING ADDRESS: STREET '\ 9 O e-70--,c---e-‘1 ri- RI do%-A1-\ t c� 1 i <br /> CITY 1M{ 21 ZV 1 tl_-� STATE WPC Z1p q `�a7-^ l <br /> —7 <br /> APPLICANT PHONE: 6 U '--{`-+i l APPLICANT EMAIL:_f t GG of-lAe fre_ ,n,.e C em`?M <br /> PRIMARY CONTACT: 0 OWNER I!d'APPLICANT 0 OTHER(Architect, Engineer, Etc.) , <br /> CONTACT NAME: CONTACT PHONE:4)Z �p(„ —t 1 14 c4r q Co') ?C t ('C-1 ` L41/ <br /> 0 v .._._ v LT— CONTACT EMAIL: p,,,,t� A3 -A a, %/ <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must <br /> comply with current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be <br /> authorized in writing from the Building Official before being authorized under any circumstance.I am the owner,or am authorized by the owner of this property to <br /> perform the work for which application is made,and t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> (..? _____\_".1\:77==' ( (4107t 6 l8®1--003 <br /> l <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />