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PLIC WORKS PERMIT 'PLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: o �, IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) D&S'l6N ?-4e-'jI£V-j SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAM ILY OCOMMERCIAL ❑INDUSTRIAL CHANGE OF USE? ❑ NO YES, FROM P-IF_ 1-tL tp TO Qr: NEW WATER/SEWER SERVICE NEEDED? ❑ NO Z YES,TYPE 4- SIZE SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: S V �ST7"6, (rAPAI eW to- rb 8Z7 CAw ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ASPHALT/CONCRETE PAVING SF ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑ CLEARING/GRADING/FILL/EXCAVATE CY ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION OWNER NAME: IN I I/VI IA rh S /N\/e5sTW V-'.? OWNER MAILING ADDRESS: STREET 10 ZD v}J. Gf}S/0`✓O b Q CITY V �`C F C- STATE W, 1 ZIP OWNER PHONE: 4— 730 76Z-4- OWNER EMAIL: APPLICANT NAME: I[JS APPLICANT MAILING ADDRESS: STREET �` ' CITY &V Cn_( STATE ZIP APPLICANT PHONE: 2 '' APPLICANT EMAIL: Q V {'1 PRIMARY CONTACT: ❑ OWNER j$j APPLICANT ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: DOV67 P-0 r-ILA j CONTACT EMAIL: d��/ �Qrt tun ��0 ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained here is true and dafrect. Work done pursuant to this permit must 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 authorized in writing from the Building Official before being authorized under any circumstance. 1 am the owner,or l am authorized by the owner of this property to perform the work for which application is made,and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# j Owner/Authorize gent Signat Date (Revised 10/12/2015)