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PdPIELic (0) S PERMIT 1L CAT O <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) everefteps@everettwa.gov www.everettwagov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2-. '37_ 1 ' ►a4 tt J Everel , ton c18261 <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: ISFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? D4 NO ❑YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? It NO 0 YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> • <br /> DESCRIPTION OF WORK: kpe (Y,a C t�T 'l"L! a <br /> 'ICl1.. I.Y\ 4LLL+TDh -fro <br /> Lace,. J � <br /> cm\ vvt iv1 ) arc'. . <br /> FENCE IN ROW (y I `� 4l' FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> 0 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 /> - CONTACT•INFORMATION <br /> OWNER NAME: . *'b mann t <br /> P. <br /> OWNER MAILING ADDRESS: STREET P.-14- r4 114 CiPte. . C ^� / <br /> CITY jvor " STATE l td r j�! ZIP 9& D <br /> OWNER PHONE: +as--aT`C` Ot 3t OWNER EMAIL: Y1AD115601R WI C 11/106' CO'• 1 <br /> APPLICANT NAME: 5tot L QS a kJu'f i <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: 14OWNER 0 APPLICANT 0 OTHER(Architect, Engineer,Etc.) <br /> CONTACT NAME: V to CONTACT PHONE: Ato Q. . ex-1050-P) <br /> V) PALM �,LV' CONTACT EMAIL: <br /> ACKNOWLEDGEMENT:I have reviewed this a ication 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 I am authorized by the owner of this property to <br /> perform the work for which application is made,and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> "/Sfr i 111311 PW 1 -11-6\\ <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />