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<br /> ,4 a PLIC WORKS PERMIT ASLICATION
<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 I www.everettwa.gov/permits
<br /> 3 Mls �^.ra� .:�:�.- ;45R110704:0104011 0 010 .r�1 z ira�� - Er z���•
<br /> PROJECT ADDRESS: 75-0 S 17B_ A,„„e_ ,SE I EV F/ZTrI W A 9 a 2..O
<br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.)
<br /> SITE WORK FOR PROJECT TYPE: SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL 01NDUSTRIAL
<br /> CHANGE OF USE? IX NO ❑YES, FROM TO
<br /> NEW WATER/SEWER SERVICE NEEDED? O ❑YES,TYPE SIZE
<br /> ,'"�� r{3��i?:�'��,,�i 1A4�-t Sr,m _.-� �9`"'57`,'''eewe �eu�.»�w+,+�.��v . � ..,.:u;,�se •wt. ,+.�,:�� �:w.z,+ � '� ��,,.,..�,aoewx�:�� .��r ,�"^+ . .. ^tK'v' a�§�v �r� all 1 ,�k . . .,..,,,MeriI' .�.SITE>s:. :07-A`/ RIGHT V Y APDL CA: y_ON.INNFrORMA .I.ON :i:Te �
<br /> DESCRIPTION OF WORK: f/LL !/I.J D 11"7,W kJ /rii' DR,A-/N 12-,,ck, CO v k_. 1...,ii-'W
<br /> 01 ta-r. h-L-So ilusl'Ar_L- !o PooT FEIUCE //q baiva,rH ply PROPr `T
<br /> pc PR4vA-c- — (Ss FL 5/ / ,L\
<br /> lid FENCE IN ROW 12 irn,,7�` 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 /> s CONTACTf INFORMATION" NW V , , 3 y
<br /> OWNER NAME: t) -c-R cOoPo'2
<br /> OWNER MAILING ADDRESS: STREET 750 5 .�//17 4s M-1Jx. SE
<br /> CITY tjtei E { STATE LA44- ZIP / $2,ec_'g
<br /> OWNER PHONE: la 5ei 2 745 G OWNER EMAIL W{(0.0 pi VA C 14-O s 1.Al 1. COM-
<br /> APPLICANT NAME: 5A-M A4 1 c bV a
<br /> APPLICANT MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> APPLICANT PHONE: APPLICANT EMAIL:
<br /> PRIMARY CONTACT: /0 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 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 /> I, I7 /2 /7 PW /704 - 047
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
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