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47ETT PL_ LIC WORKS PERMIT A 'LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> - <br /> PROJECT ADDRESS: S U..- LY r"t1 L.. 7 & v4r-e L <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:PSFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY OCOMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? NO ❑ YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? , No 0 YES,TYPE SIZE <br /> SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: <br /> FENCE IN ROW FT IN HEIGHT <br /> O 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 /> klia ON 011001 4700:N t p '.. , .n 's tnt' <br /> OWNER NAME: /^'a <br /> OWNER MAILING ADDRESS: STREET SOIL lL-/ ' PL 5& <br /> l CITY &V !-e- '/ STATE �,// //� ZIP 9 <br /> OWNER PHONE:10IY <br /> 6- CP (G" /j OWNER EMAIL: M.Chhti- ' (- ita-t /-Cc'01 <br /> APPLICANT NAME: <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: OWNER ❑APPLICANT ❑ 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.lam the owner,or lam 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 /> /le $ ��s" PW <br /> Owner/Authorized Agent Signature Da (Revised 10/12/2015) <br />