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PLIC WORKS PERMIT ALICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> - 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I https://everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 750, K <br /> SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ritti<sTRIAL <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) <br /> IF APPLICABLE: 0 FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# <br /> UTILITY COMPANY'S NAME&JOB#: JOB# <br /> DESCRIPTION OF SITE WORK/RIGHT-OF-WAY WORK <br /> FILL I ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: <br /> FENCE IN ROW oz 1.I✓(4i3F'(..4I4)) FT IN HEIGHT <br /> ❑DRIVEWAY APRON/CURB CUT FT WIDE <br /> ❑ASPHALT/CONCRETE PAVING SF <br /> ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> ❑CLEARING/GRADING/FILL/EXCAVATE CY <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> ❑POLE WORK/AERIAL/OVERLASH LF <br /> ADDITIONAL DESCRIPTION(AS NEEDED): 2.2 LF GF C$.44. t- L u44 - F t-cicL (zai q-r.(c.) TO CDi o•cEE-T <br /> EocP6T/iato 472.uG77-42-E 7V 40L-F (-# /a 4-F r4-I1-ST- Mar ,z Z4-D GA-T <br /> CA 7;Ic--ei/ Z G €__b f,lGr-/ cv/ sem-c ?-A-ft- ' )LA-,LL -P 4) P-(b <br /> f}P.l fl ,4 55 . Fly Map f126&1/41-CY e-c- - A4 121-4. a.SY 600E • <br /> CONTACT INFORMATION <br /> OWNER/APPLICANT NAME: P(I C!-[Dli44 (►? Nit-to/...1 <br /> OWNER/APP. MAILING ADDRESS: STREET G1. O IL <br /> ( $_L -D jGN-I � AD <br /> l ,, <br /> CITY �v STATE �J"A- ZIP eiS2. .�Zj <br /> OWNER/APP.PHONE:42. -444'2Ta( OWNER/APP. EMAIL: /l!/ek .IAC&4fj64-! P $4c 4I4(02sJ)P• GOM <br /> CONTRACTOR NAME: if-i4IZ coMMt2L(At- c N'5TIQ,.Uc7.7° J, /F L . <br /> CONTRACTOR ADDRESS: STREET p D- 66,K I D 17 • I^ <br /> CITY /�4-jG- ,.. S MV IE �SSTATE Cu4 ZIP ch62 <br /> CONTRACTOR PHONE:4-24_ 3;c- (`7 CONTRACTOR EMAIL: 5AL44 6 14PR.FE1644E. COM 2 <br /> CONTRACTOR LICENSE#(REQUIRED):MG'/PROP/ '//4 12-4 EVERETT BUSINESS LICENSE#(REQUIRED):06 37,SG <br /> PRIMARY CONTACT: ROOMER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) 1c4-3- 3 <br /> CONTACT NAME: CONTACT PHONE:4-?4-4-1-4--,70/ <br /> /l/IC'64. ILi L-' C J CONTACT EMAIL: 4 1 Ck/tejSo' C f1Z¢P'GrQQL(P.cat, <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.lam the owner,or lam 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 /> /'.j V. (4, 2 7(O PW r l/ ®?� <br /> 0 er/Authorized Agent Signature Date (Revised 1/52017) <br /> �Z 1 <br />