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#0, _r_w <br /> P1 LIC WORKS PERMIT Pi ?LIGATION <br /> ,14 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: /5Q I ./1GPOa7 Q ,Q <br /> / I '`V e- <br /> IF APPLICABLE: ❑ LAND USE PR�OJEECCT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:USER-DETACHED ❑SFR-ATTACHED ❑DUPLEX DI MULTI-FAMILY ❑COMMERCIAL El INDUSTRIAL <br /> CHANGE OF USE? ❑ NO ❑YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? ZIO ❑ YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: ,105 I47 �✓'Gvl i f-ex) /Alt �Q.0 r` -ei'/C-e . <br /> FENCE IN ROW 3.5/, A..rT 6.--r+h ✓`ccz/FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> ❑ASPHALT/CONCRETE PAVING SF D I 'I <br /> I=1 RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF nJ <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT JUL 2 0 2018 <br /> ❑ CLEARING/GRADING/FILL/EXCAVATE CY CITY OF EVERETT <br /> ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF Permit Services <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> // CONTACT INFORMATION <br /> 77�� <br /> OWNER NAME: K;Chcxfd Pct. I i illGat/ <br /> OWNER MAILING ADDRESS: STREET /-1-6( /1/c <br /> / u/ c(( i./.e. <br /> CITY 6/ere STATE Wi <br /> ZIP ? '( <br /> OWNER PHONE:1- 2).--- 4 /i ZrZ ) OWNER EMAIL: e 1/'gA,01vq a - / C <br /> fyl , ' <br /> APPLICANT NAME: SQ.,-,?-e_ <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: W <br /> ONER ❑APPLICANT ❑ OTHER(Architect, Engineer, Etc.) <br /> CONTACT AME:/LeZ- CONTACT PHONE: ty 2S- LI!�C- . ,5T e <br /> CONTACT EMAIL: /-.Zr f1144 rL yin r `,C X41/ <br /> ACKNOWLEDGEMENT:1 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 7..... i____________________--..._ .. <br /> 723-/ :_ _ Pw / 8©'"4- <br /> 0 33 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />