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� PI �LIC WORKS PERMIT � �` 'PLICATION <br /> ' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 36 I� S vw�� �r�l�p�.�l«e..� <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 S-Z TO U <br /> NEW WATER/SEWER SERVICE NEEDED? I`�NO ❑ YES,TYPE SIZE <br /> SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: ,� � <br /> �- u G�-�n i -�'l.J <br /> �FENCE IN ROW � �- p �' FT IN HEIGHT <br /> ❑ DRIVEWAY APRON I CURB CUT ��C,tc�-���� FT WIDE <br /> ❑ASPHALT/CONCRETE PAVING ���- SF <br /> ❑ RETAINING WALL!ROCKERY IN RIGHT-OF-WAY �/� LF <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT /�J�� FT TOTAL HEIGHT <br /> ❑ CLEARING/GRADING/FILL/EXCAVATE nf/Qr CY <br /> -� <br /> ❑ CUT/BORE IN PAVEMENT(PARALLEL) n(�� LF <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) �/�}- LF <br /> CONTACT INFORMATION <br /> OWNER NAME: q- ��n <br /> OWNER MAILING ADDRESS: sTREEr 7 g J I y �- S�-, SW � Jd� <br /> aTv Ed✓�on.�S sTnrE l�l�t ziP °I S o 2U <br /> OWNER PHONE: OWNER EMAIL: a-IeX C� vL�•JZoo• �ov+1 <br /> APPLICANT NAME: l�.q�.t�. S�.�i,wiS� <br /> APPLICANT MAILWG ADDRESS: sTReET 2�l2 Go�� � • <br /> CITY � STATE W�} ZIP q g ZQ ' <br /> APPLICANT PHONE: C`1�S Z52- ZI S APPLICANT EMAIL: n�l,civtct,(@ Z$IZa.✓cl,.i�c-�urt. c.o`� <br /> PRIMARY CONTACT: ❑ OWNER �APPLICANT ❑ OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: �l.t�� s�l.c���S�„� CONTACT PHONE: �H Z5� Z5 z- 2r S 3 <br /> CONTACT EMAIL: y�,�,0.�u,(� Z��Z a✓c�...�-�-tC,}ti rti� ca N• <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. 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official lJse Only <br /> PERMIT# <br /> o ti� �Z, �r � PW/E��'—r����- <br /> OwnerlAuthorized Agent Signature Date (Revised 10/12/2015) `�� <br /> L <br />