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PLUILIC WORKSPERMIT inaPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 ( FAX 425-257-8857 1 (E) everetteps@everettwagov 1 www.everettwagov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: J5 4/ 1 S* J SE IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) SITE WORK FOR PROJECT TYPE:' SFR-DETACHED ❑SFR-ATTACHED [(DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL El INDUSTRIAL CHANGE OF USE? al NO 0 YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? WI NO ❑YES,TYPE SIZE SITE WORK/ RIGHT-OF-WAYAPPLICATION INFORMATION DESCRIPTION OF WORK: rE p I�.curi 3 Yewe! `t�`J �J�1' r e (A) / col o toed kn e- kW fes. i� sir c . p ILk4u-K_. P r ctoprov4.9 s-e- al-ad-6J -614,0411 ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE Io 0 ASPHALT/CONCRETE PAVING SF ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT AUG 2 2018 oLi ❑ RETAINING ��, ❑ CLEARING/GRADING/FILL/EXCAVATE CY CITY O F EVERETT ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF Permit Services ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION OWNER NAME: //1-441.4,1„, i+iir OWNER MAILING ADDRESS: STREET 7°l / At . 'q �l' CITY Ge /�JkVA STATE kzip. 7 g S OWNER PHONE: 4.-5/6—//3 / OWNER EMAIL W6 Yk..eldcar/ 13 nlc�c.G m.. APPLICANT NAME: 4,t. APPLICANT MAILING ADDRESS: STREET CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: ,OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 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# -7-,78-/9 PW / 808 062 Owner/Authorized Ag.• s •nature Date (Revised 10/12/2015)