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477 P CLIC WORKS PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 9 S" <br /> IF APPLICABLE: 0 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? 0 NO 14YES, FROM TO 41461 )tJFtLL- 1)I,1/41€A-1.- kr,r <br /> NEW WATER/SEWER SERVICE NEEDED? ❑ NO ❑ YES,TYPE SIZE <br /> SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: �/i AI £ / 627 / , <br /> ❑ FENCE IN ROW FT IN HEIGHT <br /> tit DRIVEWAY APRON/CURB CUT I 0 FT WIDE R e,v; e <br /> [,ASPHALT/CONCRETE PAVING /0 fx 57 SF yn e 9/S E- • <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> ❑ CLEARING/GRADING/FILL/EXCAVATE CY <br /> ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> '11p <br /> � CONTACT INFORMATION <br /> OWNER NAME: p ai'l 'A <br /> OWNER MAILING ADDRESS: STREET 1 w(YJU& S k <br /> CITY 0^( � : " STATE Loa' ZIP 6))7C301 <br /> OWNER PHONE: `4).-5 , i 3c OWNER EMAIL: 6 3i \Vex v-% . <br /> APPLICANT NAME: J4 y1t 7 ( 1.N 1 1 ( Gi_/►"-� <br /> APPLICANT MAILING ADDRESS: STREET 5 0,0,‘„Q, <br /> CITY STATE ZIP <br /> APPLICANT PHONE: �� APPLICANT EMAIL: <br /> PRIMARY CONTACT: I2'OWNER 0 APPLICANT ❑ OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: `'i ), 4 13 <br /> 74-y,(1 \. <br /> LXJ 1 \V t (1,_-) CONTACT EMAIL: �A.) V end, (�1 <br /> ACKNOWLcDENT: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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 1A.,{1 /.6, 1( l PW (00(0-1t3(i <br /> Owner/ uthoriked Agent Signature Date (Revised 10/12/2015) <br />