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PLC WORKS PERMIT •PUCATON <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 INF II'.1I'IATION <br /> PROJECT ADDRESS: / /3 o uemU '� — — <br /> IF APPLICABLE: 0 LAND USE PRO JECT#(SEPA, PRE-APP,SS, ETC.) ___ <br /> SITE WORK FOR PROJECT TYPE:❑SFR DETACHED ❑SFR-ATTACHED IvtDUPLEX ❑MULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL <br /> CHANGE OF USE? 12 '• ❑YES, FROM TO - <br /> NEW WATER/SEWER SERVICE NEEDED? ❑ NO ` ES,TYPE 3 / +" 1M4`SIZE <br /> i <br /> r T-OF- `AY NI"PLICATI� IN INF aRIlVATIO�'� <br /> SITE ,,�.®1��1�,,f,/��,,1�1p-I /.` _ beA_DESCRIPTION OF WORK: V(,(,b e ues vg vN' Iv /0 CUx° -S((10� -L ,/ t <br /> I <br /> ❑ FENCE IN ROW FT IN HEIGHT <br /> ❑__,, DRIVEWAY APRON/CURB CUT FT WIDE <br /> L1"ASPHALT/CONCRETE PAVING V,Z) SF <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> D RETAINING WALL/ROCKERY OV _75N HEIGHT FT TOTAL HEIGHT <br /> CLEARING/GRADING/FILL EXCAV CY <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> 0 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> C�/ONTACT�IN/FORMATION <br /> OWNER NAME. �IVe-+t CI(� /�C.�i ICQ Li <br /> OWNER MAILING ADDRESS: STREET rAD _ OS I - _ ` '7 <br /> z CflYef,tkoSTATE A ^ZIP 7.2x5A / 2OWNER PHONE:(3 0 3-,51-7 <br /> OWNER EMAIL. cC�'(Q G�1� Gt e , l' l-�✓�A <br /> APPLICANT NAME: OyE ii(4.4(ie_ eeS(d W LK LLc, <br /> 1) <br /> APPLICANT MAILING ADDRESS: STREET 3 ' ' I <br /> CITY YY <br /> STATE 1/i`A' ZIP ( 2- <br /> APPLICANT PHONE:@64 2/ --tem APPLICANT EMAIL: .CL. / Q.A. Ca, %Aa; < y✓' <br /> PRIMARY CONTACT: ❑ OWNER PPLICANT ❑OTHER(Architect, Engineer, Etc.) <br /> CO TAT NAME: CONTACT PHONE: 2 r3 -- �� <br /> igltddK k) (c—GW(✓�'r �� CONTACT EMAIL: e-L� ,P/ (,? (e)j_ / ) i' <br /> ACKNOWLEDGEMENT I have reviewed thlcation and confirm the information contained herein is true and correct Work d�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 1 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 /> 1 / �7 P 7 [O -- 0/i <br /> Owner/Authorized Agent Sign.6 Datee (Revised 10/12/2015) <br />