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OLT P3LIC WORKS PERMIT APPLICATION <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 INFORMATION <br /> PROJECT ADDRESS: 7805 40TH AVE W <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 <br /> CHANGE OF USE? C7 NO = YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? = NO = YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: SITE WORK FOR EX BUILDING/ PARKING ETC <br /> LI FENCE IN ROW FT 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 /> = CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: GEORGIU GHEORGHE & EUGINIA <br /> OWNER MAILING ADDRESS: STREET 5810 86TH PL SW <br /> CITY MUKILTEO STATE WA zip 98275 <br /> OWNER PHONE: (OWNER EMAIL: <br /> APPLICANT NAME: (AppNamel <br /> APPLICANT MAILING ADDRESS: STREET [AppAdd] <br /> crTY [AppCi] STATE [AppSt] ZIP [AppZip] <br /> APPLICANT PHONE: [AppPhone] (APPLICANT EMAIL: [AppEmail] <br /> PRIMARY CONTACT: = OWNER = APPLICANT = OTHER (Architect, Engineer, Etc.) <br /> CONTACT NAME: [ContactName] CONTACT PHONE: [ContactPhone] {, <br /> CONTACT EMAIL: [ContactEmail] <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 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 /> PW1 803-007 <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br />