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--,,,f. . _ <br /> �� PL,,JUCC WORKS PER1LITILPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ( (E) everetteps@everettwa.gov j www.everettwa.gov/permits <br /> PROJECT SITE INF*i..IVI kTION <br /> PROJECT ADDRESS: 7717 I itv4C€a✓ r�' G vei - '(i 0 ` ,t A! .4 N$ ') �tt 17 <br /> 'IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) 1i <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED jADUPLEX ❑MULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL <br /> I CHANGE OF USE? 0 NO 'AYES, FROM r 2 TO (✓ T / <br /> 7L — Co hol <br /> NEW WATER/SEWER SERVICE NEEDED? El NO it YES,TYPE p 1 C f 4e4'4(e II, SIZE G <br /> SITE IRK/ IGHT-OF-WAY APPLICATION INF I'G1�iATION <br /> 1 ���e 4 t/-��eJ <br /> DESCRIPTION OF WORK: Pell, �a'�J r /y f P , Pep w f Z �1' <br /> O FENCE IN ROW FT IN HEIGHT <br /> O DRIVEWAY APRON/CURB CUT FT WIDE <br /> ,ASPHALT/CONCRETE PAVING I er e SF <br /> O RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> O RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> CLEARING/GRADING/FILL/EXCAVATE l ao CY <br /> O CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> O CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> /eCONTACT INFORMATION <br /> X14441/ <br /> OWNER NAME: 3-2 I l`i S7 "v .. (-1-- <br /> OWNER MAILING ADDRESS: STREET I . `( —` 1 ri. /V. -ert 11 <br /> pCIITY la.,r 6 Ivy STATE/ L ZIP 9GaJ7 <br /> OWNER PHONE: 2 G G '.1.'/ ,P_,7 70' WNER EMAIL: Gtil h Al , `i 9-,'re G-"xl/.6_0)1 <br /> APPLICANT NAME: L-eCat f A5 t91 G0 a /'/'Ac4; , (- -.6. <br /> APPLICANT MAILING ADDRESS: STREET l 7177 ,F• Pi'# `/0 AA/-"' p` Ga`' <br /> CITY pa 1.4S!G ii STATE 1,4— ZIP P1'17.? <br /> APPLICANT PHONE: 14'1ST_al D. 62fa APPLICANT EMAIL: /0 r4"(Y 2..e.4-4 2.14 el./i ii'!' 60/4w-.�._> _.�...._�.,-��.....>.,.....�.,..:M� ,.�..,....__._...._...,,.._.,..,....,_a,_ _r :....,. _..._..�. ,-._.. i <br /> PRIMARY CONTACT: D OWNER pitAPPLICANT 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: <br /> / `/ CONTACT PHONE: X5-,'7 O. 0.'.I-O l <br /> p Y„/( ivt-e hG.lti CONTACT EMAIL: A,S1 Y ZaG 174./4 e to >1 ti'.l •Gch <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.lam the owner,orl 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 /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />