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01,77 PWILIC WORKS PERMIT UPLICATION <br /> CITY OF EVERETT PERMITS ICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> *�,PROJECT'SITE INFORMATIONxS <br /> PROJECT ADDRESS: (j Z.2.0 Eve—r fr ef? <br /> IF APPLICABLE: D LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:DSFR-DETACHED ❑SFR-ATTACHED El DUPLEX El MULTI-FAMILY g(COMMERCIAL DINDUSTRIAL <br /> CHANGE OF USE? A NO 0 YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE <br /> SITE WO10- RIGHTS 0010 0:410ATION t1NF 1- ATION 4 4e,,_ Zu.• s_ 4 „ w <br /> DESCRIPTION OF WORK: Add (a41,40_0(-e, rl fr /alit, a . <br /> ❑ FENCE IN ROW FT IN HEIGHT <br /> D DRIVEWAY APRON/CURB CUT FT WIDE 3>e 'g /, vs, <br /> 9 ASPHALT!CONCRETE PAVING SF I <br /> da <br /> D RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF • <br /> -4)//D)r <br /> D RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT f[ ` l <br /> D CLEARING/GRADING/FILL/EXCAVATE - CY Ct b <br /> D CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> D CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> • C , <br /> ONTACT LNFORMATION .' <br /> OWNER NAME: San/eYS /A1/C. <br /> OWNER MAILING ADDRESS: STREET //'V '' ✓F /p 7X 22-2-6D <br /> CiTy ge-/ !sesSTATE',I/�--19g.e. <br /> OWNER PHONE: <br /> t' We// -V/J�/ S ,`vr✓) <br /> V.2-4- '�7rJ�� f'o OWNER EMAIL: c��2Y <br /> APPLICANT NAME' L'CO/'CL ...��TM��-,^Y, •�C,TZ>KS' <br /> APPLICANT MAILING ADDRESS: STREET i6y1)5 S B7's',— <br /> art <br /> , -CITY // V'e STATE &li ZIP g C dp )p <br /> APPLICANT PHONE: 23S6 9' APPLICANT EMAIL: /11/,h'7 4<<Lo✓dC0r+deSr5"CbYh <br /> PRIMARY CONTACT: 0 OWNER APPLICANT 9 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: L CONTACT PHONE: �(p— <br /> Rat ��I CONTACT EMAIL: Mike/74 C rte. G CeP✓d Ca✓1 <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 ROW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> PW <br /> (Authorized Agent Signature Date (Revised 10/12/2015) (7.—• <br />