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Plit—LIC WORKS PERMIT APLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 ( (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />[PROJECT ADDRESS: [-iv0 1oDTH P/, SE WP-fL5-7 W A ci 97,O <br />IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) <br />SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX <br />CHANGE OF USE? VNO ❑ YES, FROM <br />NEW WATER / SEWER SERVICE NEEDED? NO ❑ YES, TYPE <br />MULTI -FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br />TO <br />SIZE <br />SITE�WORK/`RIGHT OF WAY APPLICATION INFORMATION <br />DESCRIPTION OF WORK: 150SF A,P.t/t1 <br />C4-eif S/Ck A f kv <br />5 r r (qu* <br />cwl crt slA t% <br />1 ?iU os ar T Ad powl 4 <br />tot <br />❑ FENCE IN ROW <br />FT IN HEIGHT <br />❑ DRIVEWAY APRON / CURB CUT <br />FT WIDE <br />ASPHALT / CONCRETE PAVING <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY <br />LF <br />❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT <br />FT TOTAL HEIGHT <br />❑ CLEARING / GRADING / FILL /EXCAVATE <br />CY <br />❑ CUT/BORE IN PAVEMENT (PARALLEL) <br />LF <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) <br />LF <br />APPLICANT NAME: >1vLX- Ry GVIA TE Cj y 1VL N L <br />APPLICANT MAILING ADDRESS: STREET I I I sj. 1/1 9t. S cA k "Too % d Gj [CJ 1/ <br />CITY S/� 'R 4� �� STATE "" �7 ZIP • 00 <br />APPLICANT PHONE: i�J APPLICANT EMAIL: 1n9S✓1?r•ex ✓-dV l'C f S. Gc'm <br />PRIMARY* CONTACT: ❑ OWNER APPLICANT ❑ OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: CONTACT PHONE: <br />CONTACT EMAIL: <br />_s <br />ACKNOWLEDGEMENT.I have reviewed this appucauon ana connrm me unonna❑vn cunLdu,au ncrau115 it UV a„u �W„���. ��� u� �N �uu .. ••••� ram•••••• •••- <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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />PW m-' <br />Owner/ uthorized Agent Signatu Date (Revised 90/92/2095) <br />