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. . PUBLIC WORKS PERMIT APPLICATION <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 /> PROJECT ADDRESS: / Q( / C/ da Dr / &-eig r•e 1'/ 1 8 <br /> ' 9 'Z 3 <br /> 'IF APPLICABLE: K LAND USE PROJECT#(SEPA,PRE APP,SS, ETC.) SS /7-2Qz <br /> SITE WORK FOR PROJECT TYPE:I SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX DMULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL <br /> CHANGE OF USE? , NO 0 YES, FROM TO - • <br /> /� G <br /> NEW WATER/SEWER SERVICE NEEDED? 0 NO ,OYES,TYPE o (.G/ ,,^ �yS^u �fSIZE Z�r P"� p /i Pvc <br /> L-- SITE @ O12I( IOI=I�'-1( '. APP�IOA`�IOG INF.RiVIATIOi <br /> DESCRIPTION OF WORK: Ji c,: / (,� 5-7/1',11DJ�LjYjOV� CL/ 11.07 /�D4C <br /> ` 74-i? 1' C,, 5--LD7Z S�c r/ PAL • <br /> ❑ FENCE IN ROW FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> 0 ASPHALT/CONCRETE PAVING "2.go() 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 760 CY <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) Wit: LF <br /> CONTACT INFORM .1-11 9IS <br /> OWNER NAME: 611.1 S /-62 rd 61zi S' Gl C.."Dn S / cX ow/ ///C <br /> OWNER MAILING ADDRESS: STREET PC /f342( / 2 4'3 <br /> i 4 iis 7 5 vJ/6 CITY STATE alb ZIP q0 q <br /> Z7C <br /> OWNER PHONE: 1/Z 5 8'76 — 6 557 OWNER EMAIL: a-171 L( h°me S 6) y /1?a iv. 0,/s7 <br /> i APPLICANT NAME: - Paw. Ai,c7Larrl <br /> APPLICANT MAILING ADDRESS: STREET SQ,74-2._ <br /> CITY STATE Z11> <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> . <br /> PRIMARY CONTACT: 0 OWNER ❑APPLICANT OTHER(Architect, Engineer, Etc.) 1r e2.-,— <br /> CONTACTnNAME: / CONTACT PHONE: L�Z.5 — 334- '7 5,?(G G` 7--7aQ a/ CONTACT EMAIL: f"i/ jar a// 6, yaAor 62,- . <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done fiursuant 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 /> 1 <br /> PERMIT# <br /> Allii." -'/ 71)-1,- 0-.0 2 , <br /> ' ' 180.2 - 0� 1 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />