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0 <br /> P BLIG WORKS PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 27// I2 -St, E 4 .p- <br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT <br /> �TYPE:❑SFR-DETACHED ❑ L7M ❑ <br /> SFR-ATTACHED ❑DUPLEX ULTI-FAMILY COMMERCIAL ❑INDUSTRIAL <br /> L`S <br /> CHANGE OF USE? NTYO ❑YES, FROM 1K <br /> TO <br /> NEW WATER!SEWER SERVICE NEEDED? tK NO ❑YES,TYPE SIZE <br /> SITE WORK RIGHT-OF-WAY APPLICA�TIONINFORMATION <br /> DESCRIPTION OF WORK: lZ 'Pf*neS / Q!H IL A, CQ_S (;Z)AbgZ <br /> ❑ FENCE IN ROW FT INH IGHT TA9 �� <br /> 1'}� n <br /> ❑ DRIVEWAY APRON!CURB CUT FT WIDE �yt2t�ofi- f� <br /> ❑ASPHALT/CONCRETE PAVING SF —`Gy'�'r <br /> /_I <br /> ElRETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF r r�t - t' e <br /> l QgP / <br /> 1-1RETAININGWALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT Qa7✓� S-�� pt/1 <br /> ❑CLEARING/GRADING/FILL/EXCAVATE CY A ` ' �J�C�-r��•(�y(fr <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: / ,Bien <br /> OWNER MAILING ADDRESS: STREET <br /> %y E�vQ STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: Id4. vha ON <br /> APPLICANT NAME: <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑APPLICANT [OTHER(Architect, ngineer Etc.) C_v.1 <br /> CONTACT NAME: -- CONTACT PHONE: ZoG — ZZ 3 — 03.2(a <br /> Sot vu Ts,,, [A CONTACT EMAIL: St-suck; yek n. mi clow► � COw1 <br /> ACKNOWLEDGEMENT.I have reviewed this application and confirm the information contained herein is true and correct. Work done pu ant to this permit must <br /> comply with current federal,state,and local law.The granting of 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/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 /> Owner/Authorized Agent Signature Dae (Revised 1011212015) <br />