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CITY OF EVERETT PERMIT`, ..,VICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P) 425-257-8810 j FAX 425-257-8857 j (E) everetteps@everettwa.gov j www.everettwa.govlpermits <br /> �. <br /> MA' <br /> PROJECT <br /> .ROJECT.S.ITE:'INFORM <br /> P - <br /> PROJECT ADDRESS: Z L® d <br /> IF APPLICABLE: ❑LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE.❑SFR DETACHED ❑SFR ATTACHED ❑DUPLEX []MULTI-FAMILY OCOMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? ❑NO ❑YES, FROM TO <br /> NEW WATER I SEWER SERVICE NEEDED? E7 NO ❑YES,TYPE SIZE <br /> SITE WORK1 RIGHT=OF WAXAPPLiCATIAN INFORMATION_ <br /> DESCRIPTION OF WORK: (i/C �'�C i1 dr•>rJ,� /f-�Q4G �/ <br /> ❑FENCE IN ROW , �� j l FT IN HEIGHT <br /> ❑DRIVEWAY APRON/CURB CUT FT WIDE ' <br /> EI ASPHALT/CONCRETE PAVING SF <br /> ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> EI RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> ❑CLEARING I GRADING/FILL/EXCAVATE CY <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> CI CUTBORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION. , <br /> OWNER NAME: iD C GST <br /> OWNER MAILING ADDRESS: sTREEr /O� Q!t//� �� <br /> C <br /> CRY v?? C' l STATE ZIP z 6/ <br /> OWNER PHONE: L .2 <br /> 232 91OWNER EMAIL: <br /> APPLICANT NAME: <br /> APPLICANT MAILING ADDRESS: STREET IL-) `��''/ d✓ V�'�/ , r� G <br /> CRY STATE <br /> APPLICANT PHONE: S 2 ?/ APPLICANT EMAIL: <br /> PRIMARY CONTACT: I] 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,slate, 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,l 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 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> - s PW l M5-02q <br /> Owner/Authorized Agent Signature Date (Revised 90!92/2095) <br />