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FOLIC 0•t g S PEWIT ' F L CATION <br /> , . '/No."----1 u� <br /> CITY OF EVERETT PERMIT SERVICES ul Perm/ Vk.Mann; <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 SITE INFORMATION <br /> PROJECT ADDRESS: 7u 71 <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR AjTrACHED ❑DUPLEX ❑MULTI-FAMILY El COMMERCIAL INDUSTRIAL <br /> CHANGE OF USE? 0 NO 1,�YES, FROM C�jalriLrl, ;)�,n����oraq� TO l"la►n�GCltt��iee o -i A s � V' `'lAkketeju <br /> NEW WATER/SEWER SERVICE NEEDED? IX NO 0 YES,TYPE J SIZE/ ` <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: I/ !65Si,`1'T, O'T iive(V!O1d5' ace& lb be al, iO4 Of lank-ea i' <br /> wild Ibia 11041Ave in.eu) c2gWt d r,i-e&oa .. (off wxv Renee +I -Ff bar) <br /> w i Ce. on *0 ArortntP pro/ riy <br /> ❑ FENCE IN ROW FT IN HEIGHT jjldin 0,. <br /> DRIVEWAY APRON/CURB CUT alf FT WIDE <br /> ft <br /> ASPHALT/CONCRETE PAVING 1/ 965 SF <br /> KERY IN RIGHT-OF-WAY LF <br /> ❑ RETAINING WALL/ROC no climates -(0 ,611•4415V <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGH f fg r.c <br /> ❑ CLEARING/GRADING/FILL/EXCAVATE CY 1-6 I-) <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF J { FEB , C 2018 <br /> EDCUT/BORE IN PAVEMENT(NON-PARALLEL) LF U <br /> 'TY nE EVERETT <br /> Permit Cen i; h <br /> �? // CONTACT INFORMATION <br /> OWNER NAME: &ily��ecc LLQ' <br /> OWNER MAILING ADDRESS: STREET f 2 if /2/54 Ave. /(4 <br /> CITY gD " STATE WA ZIP V// <br /> OWNER PHONE: (204- 3742-‘4602 OWNER EMAIL: ra x'650 e ao I,cor <br /> APPLICANT NAME: dylky Jq v e4f 4 TOO l <br /> APPLICANT MAILING ADDRESS: STREET / /07A Aa vct fir A <br /> cITY eat(P_ STATE WA ZIP 9(113 <br /> APPLICANT PHONE: iga APPLICANT EMAIL: 1, <br /> �.m .m 3 ..,�..�s.,,�.__T. �...�.. ,.......4�,.... _ ha ' ..,r__________________revs ac/ aa rnrn <br /> PRIMARY CONTACT: 0 OWNER gAPPLICANT 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: Ri 4_37,2. . 1f <br /> ks - c b ('5 CONTACT EMAIL:.. 10.It Y1QCS' c64 hot alY4COYn_ <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 f. which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Air <br /> City of Everett Official Use Only <br /> .� PERMIT# <br /> OF, i/Z' PW oa -c1g <br /> ,, nerlAuthorr ed Agent Signature Date (Revised 10/12/2015) <br />