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#11111P-74 P -LIC WORKS PERMIT PLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov j www.everettwa.gov/permits 42,7: PROJECT SITE INFORMATION PROJECT ADDRESS: `2.8'2,O TeeAkki,�IA�.I� 6vemte, GV AL*i v14, t'S ZOI, l I'O$ *-°S re44/40e' teRIA0tr:-{,J IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) SEPA Cez.vupka.1-eA ION{ Pt 2 -aC Evens- SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY OCOMMERCIAL RINDTRIAL CHANGE OF USE? XNO 0 YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? 0 NO ❑YES,TYPE SIZE SITE WORK/ RIGHT OF=WAY APPLICATION INFORMATION DESCRIPTION OF WORK: f O(L.- 6F VtI iAILd -'J lVR-NAL,N M.. 140,:tL t pG(241 a-es f ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE )zt �� 1 3,E� t f k F ASPHALT/CONCRETE PAVING SF .__ I a� Lf; ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF rk 1 \ NOV 172.016 I L, ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGH CLEARING/GRADING/FILL/EXCAVATE CY CITY O F EVERETT Fermi o CUT/BORE IN PAVEMENT(PARALLEL) LF Ser�vlc� ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CO NTACT INFORMATION OWNER NAME: POS{" bf -EVQA4 OWNER MAILING ADDRESS: STREET RC2 O`j V�tJ uova&t Su;te, zsm CITY EG V STATE(jduar ZIP �2 V OWNER PHONE: 6+25) 3O'73 OWNER EMAIL: C�2IMPmti/s1,t�Pa 'EV CAM APPLICANT NAME: Sietrrt. Ars 1.8Dt/- APPLICANT MAILING ADDRESS: STREET CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: )4 OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: /� '� CONTACT PHONE: (42S) 3wg-6-7 c Ca for �►�e/zsoh+ CONTACT EMAIL: C:42,F4 44-4 (Pq e . C ACKNOWLEDGEMENT:l have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must 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 authorized in writing from the Building Official before being authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# Q Er atum..) 6a_ etoL c i 0`t- 1 / {b W 161 -o at� Owner/Authorized Agent Signature Date (Revised 10/12/2015)