|
PIT WORKS PERMIT L,I A.TI N
<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 SITE INFORMATION
<br /> PROJECT ADDRESS: \R\® lt-V '\ S \I 'e- ?, 'iA \?-;
<br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) ��__//
<br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED L�IDUPLEX El MULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL
<br /> CHANGE OF USE? ISKO 0 YES, FROM TO
<br /> NEW WATER 1 SEWER SERVICE NEEDED? ❑ NO M'YES,TYPE V.1 GIN.Q.r \ SQ &SIZE
<br /> SITE WORK l RIGHT OF WAY APPLICATION INFORMATION
<br /> c,
<br /> DESCRIPTION OF WORK: S\\-e wta-
<br /> o
<br /> N'S pc w. Uc..Qs- Vex.,t
<br /> ❑ FENCE IN ROW FT IN HEIGHT
<br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE ��� �
<br /> 0 ASPHALT/CONCRETE PAVING SF
<br /> coc4--
<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 /> CONTACT INFORMATION
<br /> OWNER NAME: �a,kkw.Acc1-Yi
<br /> OWNER MAILING ADDRESS: STREET ' -O W /1/4.1 tkY."\-Pd \\\5 A
<br /> CITY Gv.e r'e STATE WA ZIP (a�-o 3
<br /> OWNER PHONE 906 .S3 '-�D 0I OWNER EMAIL:v Q�C,,�Iel\iia, @..Y\C)'\ d��
<br /> APPLICANT NAME:
<br /> e.,.�' 1t.,.,,., ..,._...�,,.M,.,.�....,.—..,..,..,_..,,.,....,a.�.,.,.,.,,.,.,.......,..,,.M...,,...,.,..., .,...,,µ ,..,..,....M.,.,....,,....M...».,._Mti..,w....,.,.,,.,...M ,....,..,,,...,.,.M.,. _..,�....M. „M, .
<br /> 4a`\w�\c k%CC� CM
<br /> APPLICANT MAILING ADDRESS: STREET '\a-0 V.9 McA(A.\ 0 -\ve\
<br /> CITY �^V�r��\- STATE w4 ZIP 63\3 o3
<br /> APPLICANT PHONE: /j— `" 53-LjOg( APPLICANT EMAIL: PLZAK.1V I-s417. c M/c L— • CO M
<br /> PRIMARY CONTACT: tnVOWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> ACKNOWLEDGEMENT:l 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 /> I. ©� �� V� iw `�o� �a�o
<br /> Own1r/Authorized Agent Signature Date (Revised 10/12/2015)
<br /> Q./2--4
<br />
|