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(P) 425-257-8810 <br />PU�IC WORKS PERMIT A�'LICATION <br />,-. <br />CITY OF EVERETT PERMIT SERVICES ��,� �� I �"' ��'-"' <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: ,3 � � �(� Y�'('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 1� YES, TYPE D c:� r� , SIZE �X r S�' In <br />DESCRIPTION OF WORK <br />SITE WORK / RIGHT-OF-WAY APPLICATIOI <br />� � ' l�le%"-' c� �5 P C' S, <br />-� r�►� c L��� �c r Sz r v� L� l h L � <br />� C? )- (...t.'C{�-�'4, <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 />OWNER NAME: ��j� i�^� <br />OWNER MAILING ADDRESS <br />FT IN HE <br />FT WIDE <br />SF <br />LF <br />FT TOTF <br />CY <br />LF <br />LF <br />CONTACT INFORMATION <br />`/_ KS �- c7dc; �, <br />STREET � �� Z " <br />cirv ��1 �? t��: 77 . <br />OWNER PHONE: � Z j - ��� ) — <br />APPLICANT NAME: � � �-y� � <br />APPLICANT MAILING ADDRESS: srREEr <br />OWNER EMAIL: <br />�, �, �s �- � � <br />lJ <br />cirv <br />APPLICANT PHONE: APPLICANT EMAIL: <br />PRIMARY CONTACT: ❑ OWNER ❑ APPLICANT ❑ OTHER (Architect, Engineer, f <br />CONTACT NAME: CONTACT PHONE: <br />CONTACT EMAIL: <br />ACKNOWLEDGEMENT. 1 have reviewed this application and confirm the information contained herein i� <br />comply with current federal, state, and local law. The granting of a permit only authorizes approved work <br />authorized in writing from the Building Official before being authorized under any circumstance. 1 am the <br />perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCVI <br />0 <br />Agent Signature <br />�r� i�-�� �� <br />Date <br />�i^r`}� �'L1 Ct��►'� Lt � . <br />f" <br />���� � ���y � <br />_ � — / �GC'r„J:, lo+�`� I <br />�.�. N SF r i--' <br />,� � � ���� <br />„ <br />a ` <br />� �� 4 <br />,.- � < , , <br />j r, <br />._� <br />.�_" <br />4J / � <br />�`��� �C��. t� ���v^�� �� <br />� <br />��, �� <br />'' C� <br />�✓Il i %, � � <br />