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<br /> .,
<br /> ,. C1TY OF EVERETT PERMI7 � i�VICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits
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<br /> PB�0.9ECT S1�'E IIdFO�MAI°I��
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<br /> PF20JECT ADDRESS: �^oZ J �'Cc I'�-(.C,T.�t `��L'�t.. �v'ri'f tI l,V' "�-- �<J J-£'��
<br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.)
<br /> SITE WORK FOR PROJECT TYPE: STR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑1NDUSTRIAL
<br /> CHANGE OF USE? �'NO ❑YES, FROM TO
<br /> NEW WATER!SEWER SERVICE NEEDED? ,�NO ❑YES,TYPE SIZE
<br /> SITE 1MOREC/ FtIGWT=OF-WAIf�1PPLICATION IIdFORMATIOM
<br /> DESCRIPTIONOFWORK: C.vr�S��� C:'L `� � �c�l� �`"��( �-.CC�C� �}zc�-G�Lc/� "� �'�Cf
<br /> �� �k�-��- �� a � -�vt �� �����-�`t
<br /> ❑ FENCE IN ROW FT IN HEIGHT
<br /> ❑ DRIVEWAYAPRON/CURB CUT FT WIDE
<br /> ❑ASPHALT/CONCRETE PAVING SF ��(/���"` � �
<br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY �F � ��(/7�1f��� �
<br /> ❑ RETAINfNG WALL/ ROCKERY OVER 4FT fN HEIGHT FT TOT,4L HEIGHT ��„� (`„�/ C�t��?���.
<br /> ❑ CLEARING/GRADING/FILL/EXCAVATE CY
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<br /> ❑ CUT/BORE 1N PAVEMENT(PARALLEL) LF
<br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF
<br /> CONTACT INFORMATION
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<br /> OWNEFZNAME: IC� C�.�r%-c-ti ,�l'I�Ct�V' St �V�t-✓!1- . ti.�;���
<br /> OWNER MAILING ADDRESS: sTREEr �5��� �<<L(.�u J T
<br /> CITY �V`�-'t-7 STATE I.�L'� ZIP C/r��Z'��
<br /> OWNER PHONE: � l ._- . � �� _ ����-eC,4�iv-Y1
<br /> ��S —.j �� ,�L�l Z OWNER EMAIL: -�Gt•� Cu'LG' __ �ii.{tc;v'C'
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<br /> APPLICANT NAME. '�C� Zyt '' Z 'i.�
<br /> APPLICANT MAILING ADDR S: STREET ,S�
<br /> CITY STFl7E Z�p
<br /> APPLICANT PHONE: APPLICANT EMAIL:
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<br /> PRIMARY CONTACT: '�OWNER ❑APPLICANT ❑ OTHER(Architect, Engineer, Etc.)
<br /> CONTACT iVAME: CONTACT PHONE: l',�(� 3i�� ,Z-t�j� L���—„3.5� - '�f`j
<br /> �' � CONTACT EMAIL• � �
<br /> Il,c-{�:C.�'��L4 �2��<-C��� �.f ��.siL:� _��.�1��'V �"� c L�%• Lc`.':"Yi__.
<br /> ACKNOWLEDGEMENT.�1 have reviewed this application and confirm the information contained fi in is frue and correct. Wor/c don pursuant to this permit must
<br /> comply with cur�enf federal, sfafe, and/oca/law. The granting of a permit only authorizes approved worlc and no deviations therefrom.Deviations must first be
<br /> authorized in writing from fhe Building Otficial before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property fo
<br /> perform the�vork for whrch applicafion is made,and I comply with fhe State Contractors Law 98.27 RCW and 296.200A WAC.
<br /> Cify of Everetf Official Use Only
<br /> -- PERMIT#
<br /> ,� � %l �� i�-- ��
<br /> Owner/Authorized AgenE Signature Date (Revised 10/92/2095)
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