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_ P BLIC WORKS PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT-/ICES <br /> 3200 CEDAR STREET, EVERE`(T, WA 98209 <br /> (P)425-257-8810 J FAX 425-207-8857 J (E)everetteps@everettwa.gov( www.everettwa.govlpermits <br /> PROJECT ADDRESS; d. ,? G /4vc' <br /> IF APPLICABLE; EI LAND USE PROJECT#(SEPA,PRE APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:CISFR-DETACHED C1SFR ATTACHED ❑DUPLEX 0MULTI-FAMILY CICOMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? NO 0 YES, PROM TO <br /> NEW WATER t SEWER SERVICE NEEDED? NO 0 YES,TYPE SIZE <br /> VII®RIFCI 13CCI�'ti' ® VNAf 1�PPL,SCA'i'1<®!! '�>hl�®R1V9�#'>t' �►N <br /> DESCRIPTION OF WORK; �racc�cJto <br /> a '1 r �= <br /> ❑FENCE IN ROW FT IN HEIGHT <br /> CI DRIVEWAY APRON/CURB CUT 1=I"WIDE <br /> ASPHALTI CONCRETE PAVING SF <br /> E1 RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> 1:1 RETAINING WALL I ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> 0 CLEARING I GRADING t FILL/EXCAVATE CY <br /> ❑CUTBORE IN PAVEMENT(PARALLEL) LF <br /> 0 CUTIBORE IN PAVEMENT(NON-PARALLEL) LF <br /> . __._- .._....• ,•.�QNTAGT.INFORiVIATi®H .. -.' <br /> OWNER NAME: IE%tir <br /> OWNER MAILING ADDRESS. sTREET hNz- �— <br /> GrIY C, ZIP <br /> OWNER PHONE. OWNER EMAIL: <br /> APPLICANT NAME; pl-' ^v �—� ca 11C• <br /> APPLICANT MAILING ADDRESS. STREET .5 <br /> CITY STATE <br /> APPLICANT PHONE, ILA %556-66 APPLICANT EMAIL; <br /> PRIMARY CONTACT: 0 OWNER APPLICANT 0 OTHER(Architect, Engineer,Etc.) <br /> CONTACT NAME; CONTACT PHONE: 2o6 A 51 6--66 a9 <br /> PU' CONTACTEMAIL: 0 !vta.,��.� ,plc <br /> ACKNOWLEDGEMENT l 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,l am the owner,or/am authorized by the owner of this property to <br /> perform the work for which appifcafion 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 /> OwnerfAutherized Ag Signature Date (Revised 10/12/2015) <br />