Laserfiche WebLink
(P) 425-257-8810 <br />PI LIC WORKS PERMIT � PLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: � lO �'� -',�/�� l� L�- �, � <br />IF APPLICABLE: ❑ LAND USE PROJECT #(SEPA, PRE-APP, SS, ETC.) <br />SITE WORK FOR PROJECT TYPE:�SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br />CHANGE OF USE? �NO ❑ YES, FROM TO <br />NEW WATER / SEWER SERVICE NEEDED? ,f� N0 ❑ YES, TYPE SIZE <br />SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION <br />( ,� , �� <br />DESCRIPTION OF WORK: C-, rn �� i G�-t \y1�� ����L? �..� ��, ��'�( �. � O <br />� <br /># �� <br />❑ FENCE IN ROW <br />❑ DRIVEWAY APRON / 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 />FT IN HEIGHT <br />FT WIDE <br />SF <br />LF <br />FT TOTAL HEIGHT <br />CY <br />LF <br />LF <br />� <br />comply with current federal, state, and local law. The granting of a perrnit only authorizes approved work and no deviations theref�om. Deviations must first be <br />authorized in wrifing from fhe Building Official before being authorized under any circumstance. 1 am the owner, or I am authorized by fhe 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 />� , PW��U�-a���� <br />� , �. - <br />Owner/A horized l�qent S'(qnature Date (Revised 10/12/2015) <br />