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P•L C Wil ''rn KS PE[ d 0T •PUCAT .NI <br /> CITY OF EVERETT PERMIT SE <br /> RVICES <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: .510 4- 8 4'Lt-ui AVE <br /> IF APPLICABLE: 0 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 0 YES,TYPE SIZE <br /> SITE WORK`/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> .DESCRIPTION OF WORK: f& -e. 0 1- 5.041-P-- <br /> 116NCE IN ROW (Q -P-4" L%VAGJ [►kJ .i 7T IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> ❑ASPHALT/CONCRETE PAVING SF <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> ❑ CLEARING/GRADING/FILL/EXCAVATE CY <br /> ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> 0 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT`INFORMATION <br /> OWNER NAME: TAAAAES11/4AA--C--t-AC4-U-K-P3 <br /> OWNER MAILING ADDRESS: STREET 1 4— 47,4`J'W // i <br /> CITY STATE� ki.1.,ik" ZIP 7 g 203 <br /> 4 <br /> OWNER PHONE '25 a 3( G>It OWNER EMAIL: tmax—iet4,(. T►_�'�^j ctet4 <br /> APPLICANT NAME: <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL:wJ __ <br /> PRIMARY CONTACT: OWNER �'❑APPLICANTS 0 OTHER(Architect,`Engineer, Etc.)! M W <br /> IY <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <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.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 ii 11- pw1.7V -03$ <br /> ‘sevGner/Authorized Agent Signature Date (Revised 10/12/2015) <br />