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0 <br /> PUE3JIC WORKS PERMIT LIC i TION <br /> #1141P/A0 iiii,,b,,,,_,,,,-..-1 <br /> veigi 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: GC-�/ 7 rafi".+ ,� .1 i/-4 r VI-�t' 1,V/A f q <br /> .c6 i <br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:L::1SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY El COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? G- O ❑YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? 111 NO ❑YES,TYPE SIZE <br /> SITE WORK I RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: Y.i ig-c./ -' iir 4-bail1/1'k--- Cf-t4,e-e¢ 1/12?/h lAd v` <br /> Ir FENCE IN ROW L/l " infi (9/ /d.+ 'et 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 /> 0 CLEARING/GRADING/FILL/EXCAVATE CY <br /> ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> I CONTACT INFORMATION <br /> OWNER NAM7Ff_ 5,,,A-j,,c -)' v <br /> OWNER MAILING ADDRESS: STREET 22-)7 J' I4a,-c + Av. <br /> CITY G��,✓1. I I/ STATE 1/2/4 ZIP q''2 2 J <br /> OWNER EMAIL: /.. 55c-v1.4,,/.._e- r'�^� C'�i2tIX i f, f r->9---✓1 <br /> OWNER PHONE.�� (""?'/ ��� ._._.-. ._...... . :....._ ...,. <br /> APPLICANT NAME: <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: 0 OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) <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 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 /> ,/..--4--- ...../Z. /e. j W !SOLI-004 <br /> O ner/Authorized Agent Signature D//1- <br /> (Revised 10/12/2015) <br />