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���s� wo��� ����i����i�,��rsorv <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />I SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION � <br />PTION OF WORK: <br />�� v� <br />.,�.,�-- <br />. <br />� � v �.L— : �-� � <br />C� n- �U .2 i S� CUi/— <br />/�; a,... � ��� G F /�z <br />�,FENCE IN ROW <br />❑ DRNEWAYAPRON /CURB CUT <br />❑ ASPHALT / CONCRETE PAVING <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY <br />❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT <br />❑ CLEARING / GRADING / FILL / EXCAVATE <br />❑ CUT/BORE IN PAVEMENT (PARALLEL) <br />❑ CUT/BORE IN PAVEMENT (NON-PARALLEL) <br />�- � � <br />CG, �, �'�-'� <br />�..,..� <br />C' (� ^'�-z C /� c� %Z� <br />FT IN HEIGHT <br />FT WIDE <br />SF <br />LF <br />FT TOTAL HEIGHT <br />CY <br />LF <br />LF <br />� <br />ACKNOWLEDGEMENT: I have reviewed this applicafion and confirm the information contained herein is true and correct. Work done pursuant to tnis 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 />authonzed in writing from the Building Officia! before being authorized under any circumstance. I am the owner, or 1 am authorized by the owner of this property to <br />perform fhe work for which application is made, and I comp/y with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Cify of Evereft Official Use On/y <br />PERMIT # <br />1 W��� ���5 � <br />Owner/Authorized Agent Signature Date (Revised 90/92/2015) <br />