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(P) 425-257-8810 <br />P� .� LIC WORKS PERMIT �LICATION <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: � ' j/ <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? ❑ NO ❑ YES, TYPE SIZE <br />SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION <br />DESCRIPTION OF WORK: <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 />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. 1 am the owner, or 1 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 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />P W� 5 �2- ��t:%� <br />Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />