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PlitLIC 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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION, <br /> PROJECT ADDRESS: trn 0 /Q gime* (fly LeLetote-;v <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 CIINDUSTRIAL <br /> CHANGE OF USE? A"NO 0 YES, FROM TO <br /> NEW WATER I SEWER SERVICE NEEDED? .13(NO 0 YES,TYPE SIZE <br /> ,SITE WORK I RIGHT OF-WAY,APPLIICATI ON„INFORMA,TIO, <br /> DESCRIPTION OF WORK: ” . .. i 01P_1.E. t,.. '.t•._.• •r .. <br /> kim ) &kr& Z) .spa_to ioral,+°,.rtac-- y #-Me , recyc 14:44 (/66i.too , fru aA <br /> ca~tr�Lo c�� d td conc.re,l eeMurty au,- to sal sktakEis <br /> ❑FENCE IN ROW FT IN HEIGHT <br /> ❑DRIVEWAY APRON/CURB CUT FT WIDE *3- i w 5 <br /> AI ASPHALT/CONCRETE PAVING /I q2-7... SF (`__ ntw l ' <br /> in RETAINING WALL!ROCKERY IN RIGHT-OF-WAY LF C��__� 9 t C�Ncius <br /> 0 RETAINING WALL!ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHTtititt.44A_� CSL Y <br /> tuw <br /> ❑CLEARING/GRADING/FILL/EXCAVATE CY <br /> O CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: are-of Everett <br /> OWNER MAILING ADDRESS: STREET /Zed- efileP#$mfh1 /Day I Suite_ 2GY9 <br /> CITY el/emit7 STATE Lm`{'n <br /> ZIP 9 'zOl <br /> OWNER PHONE: qZS-2$ 3/!o41 OWNER EMAIL: <br /> APPLICANT NAME: 6ra./LG&n �t)h►'t�k� <br /> APPLICANT MAILING ADDRESS: STREET I Zb$ Gr f s mew Lacy t Sc.I.t1�a.zoo <br /> CITY ai re► STATE 1,0 let ZIP 18201 <br /> APPLICANT PHONE: ',2S-3 -0(.I3 APPLICANT EMAIL: kwft j fQ O 4,10 rigesfevete0 cowl <br /> PRIMARY CONTACT: 0 OWNER .I APPLICANT 0 OTHER(Architect,Engineer,Etc.) <br /> CONTACT NAME: CONTACT PHONE: � _ ��_�c3 <br /> 6r Ai CONTACT EMAIL: btokt ices&Par7`dfeVe.m6k '1 <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 /> - . _ 2.—l&_ --« PW I U©3-Od5 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />