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PP, UC WORKS PERMIT®R, OLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />[PROJECT SITE IMFORMA ION _. <br />PROJECT ADDRESS: <br />IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) <br />SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI -FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br />CHANGE OF USE? ❑ NO ❑ YES, FROM TO <br />NEW WATER / SEWER SERVICE NEEDED? ❑ NO ❑ YES, TYPE SIZE <br />SITE WORK / RIGHT-OF-WAY APPLICATION ➢Iall�®RVi/I�T➢®Its <br />DESCRIPTION OF WORK: <br />� <br />c <br />s�i"vlAOi <br />/ 3 <br />��a►Y//J�.� <br />❑ FENCE IN ROW <br />FT IN HEIGHT <br />S* IV 9 <br />J <br />❑ DRIVEWAY APRON / CURB CUT <br />FT WIDE <br />Q <br />❑ ASPHALT / CONCRETE PAVING <br />SF <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY <br />LF <br />❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT <br />FT TOTAL HEIGHT <br />JA <br />❑ CLEARING / GRADING / FILL / EXCAVATE <br />CY <br />❑ CUT/BORE IN PAVEMENT (PARALLEL) _ <br />LF <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) <br />LF <br />CONTACT INFORMATION <br />OWNER NAME: <br />OWNER MAILING ADDRESS: STREET S loS 3 <br />� y�O+1g <br />CITY m fV nl V STATE W 7_iP O �( <br />OWNER PHONE: �IQ6- Q- 6��i <br />OWNER EMAIL: Cjqn g2o eq (nall , C�1 <br />APPLICANT NAME: <br />APPLICANT MAILING ADDRESS: SIRED <br />STATE ZAP <br />CITY <br />APPLICANT PHONE: <br />APPLICANT EMAIL: <br />PRIMARY CONTACT: ❑ OWNER ❑ APPLICANT XOTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: Q �' <br />t f this ermit must <br />ACKNOWLEDGEMENT., I have reviewed this application and confirm the information containednerein is true and correct. Work done pursuan o p <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. l 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 />F I$06- o - <br />(Revised 1011212015) <br />