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PUOLIC WORKS PERMIT AI&LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1526 HOYT AVE <br /> IF APPLICABLE: [ 1 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: L-ASFR-DETACHED =SFR-ATTACHED =DUPLEX =MULTI-FAMILY L-1 COMMERCIAL <br /> CHANGE OF USE? = NO = YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? = NO = YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: CONSTRUCTION OF 20'X24'WOOD FRAME GARAGE <br /> = FENCE IN ROW FT IN HEIGHT <br /> = DRIVEWAY APRON/CURB CUT FT WIDE <br /> =ASPHALT/CONCRETE PAVING SF <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 /> CONTACT INFORMATION <br /> OWNER NAME: ADRIAN ROBERT F <br /> OWNER MAILING ADDRESS: STREET 1526 HOYT AVE <br /> CITY EVERETT STATE WA zip 98201-2010 <br /> OWNER PHONE: OWNER EMAIL: <br /> APPLICANT NAME: [AppNamel <br /> APPLICANT MAILING ADDRESS: STREET [AppAdd] <br /> CITY [AppCi] STATE [AppSt] ZIP [AppZip] <br /> APPLICANT PHONE: [AppPhone] APPLICANT EMAIL: [AppEmail] <br /> PRIMARY CONTACT: = OWNER = APPLICANT = OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: [ContactName] CONTACT PHONE: [ContactPhone] <br /> CONTACT EMAIL: [ContactEmail] <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 1 am authorized by the owner of this property to <br /> perform the work for which application 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 /> PW1703-024 <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br />