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<br /> CITY OF EVERETT PERMIT SERVICES
<br /> E V E R E IT 3200 CEDAR STREET, EVERETT, WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits
<br /> .��;� ...,. � , _ � . . :t=: '�RR�` ECT�$ITE:INF`� :R �1'-.'�"I: �" •
<br /> PROJECT ADDRESS: 1, 5 2 I Lc> asz.o ptiv
<br /> SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY VICOMMERCIAL DINDUSTRIAL
<br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.)
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<br /> _.:::. •DESCR�PTlOh1�<UF=SI.Yf:=1NOR��RI��T..OF...1N##,�(�WORK _
<br /> FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS:
<br /> aFENCE IN ROW •_vwm.c5 - FT IN HEIGHT STORMWATER DISCHARGES TO:
<br /> ❑DRIVEWAY APRON/CURB CUT FT WIDE ►=.Combined Sewer
<br /> ❑ASPHALT/CONCRETE PAVING SF ❑Separated Storm Sewer
<br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑Direct Discharge to Snohomish River or Puget Sound
<br /> ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS:
<br /> ❑CLEARING/GRADING/FILL/EXCAVATE CY ❑MR2 Only ❑MR1-5 ❑MR1-9
<br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES:
<br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF
<br /> ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: C SF
<br /> ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: C SF
<br /> -� FENCI WC> 4 GATES A W> S c.-.›Kk'`>A Z -1 s liPit��Af� 1 Qom D.c
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<br /> �. OWNER/APPLICANT NAME: i tI GEL LyrkzAwAk
<br /> OWNER/APP. MAILING ADDRESS: STREET 2 SZ i L-M RAD.t) .N1(_,
<br /> CITY CMG '� STATE ��f ZIP���Lv
<br /> OWNER/APP. PHONE: 2 j 2 7 OWNER ER.,/ EMAIL: rF�
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<br /> *Required for Work in Public Right-of-Way
<br /> ;* CONTRACTOR NAME: SA MS As C:NvCL 1-�
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED):
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<br /> PRIMARY CONTACT: gc OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.)
<br /> CONTACT NAME: a �;� CONTACT PHONE: 4 2.5? - 1953
<br /> CONTACT EMAIL: f3c)S � _ _ r�JM
<br /> ACKNOWLEDGEMENT:1 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 pplication is made,and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAG.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> PW 22o(b-01-k
<br /> y Owne'rAAuthorized Agent Signature D ,
<br /> ate (Revised 4/15/2019)
<br />
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