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0477 PLIC 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 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: �6061 Jr`rte SS EiVvoII/ Wrf `11c24 1 ? 004 gdd'j )1000a <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:iSFR-DETACHED ❑SFR-ATTACHED EDUPLEX ❑MULTI-FAMILY OCOMMERCIAL 0 INDUSTRIAL <br /> CHANGE OF USE? 0 NO [RYES, FROM VAUt,J / eAft KW- PM TO Nev SF,' <br /> NEW WATER/SEWER SERVICE NEEDED? El NO 0 YES,TYPE SIZE <br /> SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: t1'rr t) !r G �r'tI✓t <br /> et �' C/Z l <br /> (Al) ('fu[LIONt~ P\AD 9-i) Ftto✓vi-fACtt+1. C.-Ad t1, (rIvr AV AT LJ F JL S,0.(r FobtAJy-tV4 FO/C 10-00 6.F. 512. <br /> ❑ FENCE IN ROW FT IN HEIGHT <br /> LaDRIVEWAYAPRON/CURB CUT S() FT WIDE <br /> ASPHALT/CONCRETE PAVING 500 SF <br /> ❑ RETAINING WALL!ROCKERY IN RIGHT-OF-WAY LF <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> jg 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: kir'ri i f.L(f rt .i3-[ .L7s <br /> OWNER MAILING ADDRESS: STREET 550 ,f`-cLVF;12 ).A, ISIVQ <br /> CITY CAN 21.11— STATE til ZIP 1d:4. 1 <br /> OWNER PHONE: 1- 1. OWNER EMAIL: ( µ t, .- ILS.-!( }(!/)4,5)/2Ut,10si r. ir7 <br /> APPLICANT NAME: <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: DOWNER 0 APPLICANT El OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: LVi t'j -4'13- 011W <br /> CONTACT EMAIL: K0�_, LL;-:C^;!'�� -tc 5 . 'i/ Tf(,`,ta.^v<d:a_ <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 I 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 /> PW I So7--ozz <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />