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(P) 425-257-8810 <br />P�3LIC 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 />I SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION � <br />DESCRIPTION OF WORK: <br />❑ FENCE IN ROW <br />, E_} �-��, �:-'� 1-�f�= � � t-� <br />FT IN HEIGHT <br />❑ DRIVEWAY APRON / CURB CUT FT WIDE <br />�ASPHALT / CONCRETE PAVING � �/ � l+ X � �� /� 7SL SF <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF <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 TOTAL HEIGHT <br />CY <br />LF <br />LF <br />i-= �%(�- r?/.���( ��-� <br />ACKNOWLEDGEMENT: 1 have �eviewed 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 fficial before being autho�ized under any circumstance. l am the owner, or I am authorized by the owner of this property to <br />perform the work for which applicati 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 />�(' � �>// �/� <br />4� P W;� c,� �s — c��y <br />Owner/Authorized Ag nt Signature Date (Revised 10/12/2015) <br />