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PUS_ 1C WORKS PERMIT AP'��� �c,CITY OF EVERETT PERMIT SERVICES YL�6 <br /> �a0� <br /> 3200 CEDAR STREET, EVERETT,WA 98201 Sv) <br /> (P)42.5-257-•8810 1 FAX 425-257-8857 (E)everetteps@everettwa.gav www.everettwa.g0v/permits <br /> G�RFIJ�GT SITE AT- <br /> PROJECT ADDRESS: L r <br /> IF APPLICABLE: ❑LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.} <br /> SITE WORK FOR PROJECT TYPE:OSFR-DETACHED ❑SFR-ATTACHED ODUPLEX ❑MULTI-FAMILY IICOMMERCIAL OINDUSTRIAL <br /> CHANGE OF USE? fWNO ❑YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? ' I?rNO OYES,TYPE SIZE- <br /> . _.. ... .. . .. .. - .� ---- -- . :: .. , :_ . : ..,. ..:.:_•<_ -- _ . . <br /> S)ETE WORK'1tIG]MT-OF WAIL'APPL'IGA;TIDt IiNFA1 [YIATI0N <br /> DESCRIPTION OF WORK: J2 <br /> ❑FENCE IN ROW FT•IN HEIGHT <br /> DRIVEWAY APRON/CURB CUT 1 7 WIL))= <br /> ❑ASPHALT/CONCRETE PAVING SF _ a �`:'.+f i�;i , # <br /> ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> O RETAINING VIALI./ROCKERY OVF-'R 4FI-IJJ\I HEIGHT - - ..... 1=I !O'TAi.HFIGI rr <br /> O CLEARING I GRADING I FILL I EXCAVATE CY f=x+#,5.:.Y. C)F V r - <br /> ❑CUTIBORE IN PAVEMENT(PARALLEL) LF '`'1 ; ''''V <br /> O CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> - MATIO - -- <br /> OWNER NAME: <br /> OWNER MAILING ADDRESS: srsEEr 2 �r <br /> My STATE STATE ZJP CJG <br /> OWNER PHONE: OWNER EMAIL: <br /> APPLICANT NAME. 5 -j - <br /> APPLICANT MAILING ADDRESS: STREET <br /> My STATE Z)P <br /> APPLICANT PHONE' APPLICANT EMAIL:, <br /> PRIMARY CONTACT:�>%ff OWNER 1 '❑APPLICANT (O OTHER(Architect,Engineer, Etc.) 4 <br /> CONTACT NAME: CONTACT PHONE: 4 Z r <br /> -� CONTACT EMAIL: . <br /> ACKNOWLE'DG.EMENT 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 locallaw.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be <br /> authorized in writing from lho Building Official before being authorized under any circumstance.l am the owner,or 1 am authorized by the owner of this property to <br /> perform the work for which application is made,and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC <br /> City of Everett Official Use only <br /> F <br /> T# <br /> PW <br /> Date (Revised t0/12)2095} <br /> Owner/Authorized Agent Signature <br />