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"IP PU N. <br /> IC WORKS PERMIT LICATION <br /> �►/ : . - CITY OF EVERETT PERMIT SERVICES <br /> 4iigi3200 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 SITFORMATIO, <br /> PROJECT ADDRESS: 2J I 4-, t� 5�A <br /> 1.4) 4 E IN <br /> ALC• Alter 1 `J <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE APP, SS, ETC.) /- <br /> SITE <br /> SITE WORK FOR PROJECT TTYYP :❑SFR-DETACHED ❑SFR-ATTACHED ZeDUPLEX ❑MULTI-FAMILY El COMMERCIAL El INDUSTRIAL <br /> CHANGE OF USE? L's NO ❑YES, FROMTO - <br /> NEW WATER I SEWER SERVICE NEEDED? iLI4Io 0 YES,TYPE SIZE <br /> SITE WORK/ RIGHT OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK ........ <br /> : k rA i k, - 40�/ � p,......_,6--ie..) ('i �` L 4"J <br /> AL1 , '5' [7- t-� 0r6 <br /> 0 FENCE IN ROW FT IN HEIGHT ! -- <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE i , I I <br /> . <br /> JOA , f .......sem J'. <br /> ❑ASPHALT/CONCRETE PAVING SF ' <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF CITY O VE. TI <br /> o RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT Permit Services <br /> 0 CLEARING/GRADING/FILL/EXCAVATE CY <br /> ❑C /BORE IN PAVEMENT(PARALLEL) LF <br /> CUT/BORE IN PAVEMENT(NON-PARALLEL) '9 LF <br /> CONTACT INFORMATION <br /> OWNER NAME: Abri i ,J/&-.1Ir <br /> OWNER MAILING ADDRESS: STREET 06, 2/t`��� 5 _ Z?- 3 i <br /> CITY STREET!, <br /> i.7,--ki STATE/01...) ZIP <br /> OWNER PHONE: OWNER EMAILP-• } 1 g ✓J <br /> APPLICANT NAME: C)L--NI <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APP ANT EMAIL: <br /> PRIMARY CONTACT: 0 OWNER 0 APPLICANT OTHER(Architect, Engineer, Etc. ' 4- 1-1s ren‹... <br /> CONTACT NAME: 1 CONTACT PHONE:I..JZ .__,,,ZZ - :)SZ_, /� <br /> /3•;/1� 6 ' 4 CONTACT EM�,,,,�1)C�-�L�f',J -f►V D r <br /> correct. Work donepursuant is ermit must <br /> ACKNOWLEDGEMENT I have reviewed this application and confirm the information contained herein is true andp <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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Al: PERMIT# . <br /> Owner/Authorize Agent Sig ature Date (Revised 10/12/2015) <br />