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PUDIC WORKS PERMIT " LICATION CITY OF EVERETT PERMIT SERVICES vi 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: _. .i / ° / 4) -/ Lt E V2e ret-L bt/A %f IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAM ILY ❑COMMERCIAL El INDUSTRIAL CHANGE OF USE? 0 NO 0 YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE SITE WORK 1 RIGHT-OF-WAY APPLICATION'INFORMATION DESCRIPTION OF WORK: 7�lV Ge— o e❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ASPHALT/CONCRETE PAVINGs' '' SF yam, p e.e„. a i` ; , . , ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF 1 1 ❑ RETAINING WALL!ROCKERY OVER4FT IN HEIGHT FT TOTAL HE MI1 JUL 1 1 2018 ❑CLEARING/GRADING/FILL/EXCAVATE CY CITY Y, ,.y.. , OF EVERETT ❑CUT/BORE IN PAVEMENT(PARALLEL) LF Permit S ryIces ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION OWNER NAME: ,Tv--n_1,7 PL. WA VIM /' OWNER MAILING ADDRESS: STREET 'C �I�p 7 °7 I/V M(�tt A t /� CITY 'p(/L tett n y STATE �jF4 ZIP �/�/ OWNER PHONE. 9 I' 1� iO,T,.r OWNER EMAIL ,f7j1�t2 1 /'Cai25ea(...N, .._...r� . i , 0WI_.,.. a a� LL� �cQi� APPLICANT NAME: Tv-e, APPLICANT MAILING ADDRESS: STREET CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: 0 OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: -1-4 CONTACT EMAIL: ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must 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 authorized in writing from the Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# ` b(/) PW l( -= 014- Owner/Authorized Agent Signature Date (Revised 10/12/2015)