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PILIC WORKS PERMIT PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT ADDRESS: 1412 63RD ST SE <br /> IF APPLICABLE: O LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: OSFR-DETACHED CI SFR-ATTACHED L DUPLEX O MULTI-FAMILY 0 COMMERCIAL <br /> CHANGE OF USE? 0 NO 0 YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? o NO o YES,TYPE SIZE <br /> `ii < <br /> <_ s <br /> DESCRIPTION OF WORK: NEW SFR DETACHED <br /> tEl FENCE IN ROW FT IN HEIGHT <br /> CI DRIVEWAY APRON/CURB CUT FT WIDE <br /> =ASPHALT/CONCRETE PAVING SF <br /> 0 RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> El RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> O CLEARING/GRADING/FILL/EXCAVATE CY <br /> 0 CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> O CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> OWNER NAME: KRAVCHUK SERGEY&OLGA <br /> OWNER MAILING ADDRESS: STREET 10402 33RD ST SE <br /> circ LAKE STEVENS STATE WA ZIP 98258 <br /> OWNER PHONE:4252199149 !OWNER EMAIL: CROYALHOMES@GMAIL.COM <br /> MMM €8�C..... - - --"FJY :� «a, C° C.a�., II. .-. ra.x;,a...x....e..„... .. ,........ .....wa).. ; <br /> ....�.. ..n. ->:- .<.�.A,:de ....,,,..�� :,,,,...,. ��'�'�a.n �. .�.n.aY�„ °1"� <br /> APPLICANT NAME: OWNER <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: 'APPLICANT EMAIL: <br /> ..n..... ...:. » -ae, ...1: ” ,.a MVAI arzg Mil%--A Mita' ,V a n.:..,,::.S• <br /> PRIMARY CONTACT: 0 OWNER o APPLICANT El OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: OWNER CONTACT PHONE: <br /> CONTACT EMAIL: <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 1 am authorized by the owner of this property to <br /> perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> PW1804-012 <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br />