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km: USC WORKS RKS PEOT ?PIMA-11101''st <br /> ,/*► �. CITY OF EVERETT PERMIT VICES <br /> viio3200 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 SITE INFORMATION . <br /> PROJECT ADDRESS: 3(.Q 15 6 e., eg Lane EV eI_ A (/V /4 <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:NISFR-DETACHED ❑SFR-ATTACHED LI DUPLEX ❑MULTI-FAMILY DCOMMERCIAL 0 INDUSTRIAL <br /> CHANGE OF USE? g NO 0 YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? ►•i NO 0 YES,TYPE SIZE <br /> ....... ...... .._._. . <br /> _ <br /> SITE WORK I RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: CO S 1 Y'C' G 11 S F 4 tS*I <br /> ❑FENCE IN ROW FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE1 <br /> 0 ASPHALT/CONCRETE PAVING SF <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF • <br /> 0 RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> ❑CLEARING/GRADING/FILL/EXCAVATE QQ 1 CY <br /> ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION -_ <br /> OWNER NAME: Dani EI z &te,k1c3,0.1 F i 0 i,ppov �i .r� 2 <br /> OWNER MAILING ADDRESS: STREET I I o f-1 ici AI/ _ �V.�2S ?IM►1 IJ � 7�i <br /> S / <br /> CITY I�� `�j1 STATE vJ ]A zip "l 22 0s <br /> OWNER PHONE Li ZS 2-s i --(Q(pi,2— OWNER EMAIL: A SJ LirI a n a ,'�l,I fl r QOJO aLk _. <br /> APPLICANT NAME: s _ yYUL a 3 a\Q o V Q_ 4- 1 t <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: Ir OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <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 /> Sette <br /> Pel /q-0/- _ <br /> Owner/Authorized Agent Signa re Date Date (Revised 90/92/2095) <br />