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CPT ' OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETI , WA 98201 <br />(P) 425-257m8910 VFAX 425m257e0957 J (E) everettaps@everettwa.gov https4//Gverettwa.gov/permits <br />Yl .. 6111111 <br />' V �Y - i- V i Y 11 Y - Y i i f `Y ► Y <br />DRAINAGE <br />0 FENCE IN ROW <br />0 DRIVEWAY APRON / CURB CUT <br />t T IN HEIGHT <br />FT WIDE <br />El'ASPHALT / CONCRETE PAVING <br />Ire" iJ� 51 <br />RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF <br />RETAINING WALL / ROCKERY OVER AFT IN HEIGHT- FT "DOTAL HEIGHT <br />CLEARING / GRADING / FILL / EXCAVATE <br />STORMWA TER DISCHARGES TO: <br />FJ Combined Sewer <br />Fj Separated Storm Sewer <br />FJ Direct Discharge to Snohomish River or <br />TRIGGERED REQUIREMENTS: <br />E3 MR2 Only 0 MR1-5 13 MR1-9 <br />L <br />9 <br />Sound t <br />b �I CUT/BODE IN PAVEMENT (PARALLEL) — LF � QUANTITY OF PROPOSED HARD SURFACES. <br />I CUT/BORE IN PAVEMENT (NON-PARALLE-L) LF Proposed Roof Area: SF <br />POLE WORK / AERIAL / OVERLASH I <br />LF {Proposed Hardscape: SF <br />jADDMONAL DE3CR;F7;0N Q A3 NEEDED): IT <br />1 otal New+ Replaced: SF <br />f s Uj i <br />OWN.PP l APP. IfMIAI LING Al DRE45/S; STREET 4 TV R i C I�t A A.°� 4I`P_ <br />- - -- - <br />_ ` q <br />CITY �V �� (�i STATE �+ V A <br />(� <br />ZIP of Cl� <br />I1OWNER I A.PP, PHONE: L1 9L � .,_ (ot I o WNER I APB', EMAIL: G r rl G- � GL�/(e/pyp�\y <br />O) 0N"V% 2q <br />'Required for Work in Public Right -of -Way <br />CONTRACTOR NAME: AST '��a� I��.t �' �n � �P�rn� k It i', e v\ L L <br />ACONTRACTOR ADDRESS: STREET � � t � vIlt L5 <br />r CITY ie" STATE i�d t <br />I'< <br />ZIP 17 � !i` ✓� � <br />ONTRA :TOR PHONE: 353-0 33 4e I cawTRACTOR EMAIL, IX <br />kintkk <br />OOfr 7RA.O70R L[iCENGE (REQUIRED): h IT LDCD11 e CL ERETT S,tySUESS LICENSE #(REQUIRED): � i ►l �v" II <br />PRIMARY COPI7AC7: ® OWNER / APPLICANT CONTRACTOR 11 OTHER (Architect, Engineer, Etc.) <br />, <br />CONTACT NA.ME:/� �,�.� CONTACT PHONE: 50 ' 0 2 (�+ <br />li <br />QS'If't r�G� Illt CONTACT EMAIL: GL1� , f��� '' S 35 <br />ACICNOII LEDGEMENT I have reviewed this application and confirm the information contained herein is true and correct. Work dome pursuant to th s <br />comply with current federal state, and local law. The granting of a permit only authorizes a Airst b roust <br />9 9 p y approved work and no deviations therefrom. Deviations roust 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 <br />perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. Property to <br />City of Everett Official Use OnL. <br />IJIGi/C16xI <br />Signature <br />DERMIT <br />PW <br />1172019) <br />