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PLIC WORKS PERMIT SPLICATION <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: n2J-j<_ 700 ' ,/'d k�- f <br /> IFAPPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? ONO ❑ YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? )4 NO ❑ YES,TYPE SIZE <br /> SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: e APQ <br /> ❑ FENCE IN ROW FT IN HEIGHT <br /> ❑ DRIVEWAY APRON /CURB CUT FT WIDE <br /> 'ASPHALT/CONCRETE PAVING rf�323 SF Pew 1 � <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF JL1� dla '1".. e <br /> ❑ RETAINING WALL!ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT V7 <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: <br /> OWNER MAILING ADDRESS: STREET < 2Up <br /> CITY ExAfr STATE ZIP z6 <br /> OWNER PHONE: Lt25- z_S-j-3j&q OWNER EMAIL: <br /> APPLICANT NAME: 13raAae3n <br /> APPLICANT MAILING ADDRESS: STREET JzoS C_ra1C1t44r1Z1 2Q2 <br /> CITY LA!�r STATE Wl1 ZIP 'JEW I <br /> APPLICANT PHONE: 2 - - (p/ APPLICANT EMAIL: q�/�� peANereffcomIC <br /> PRIMARY CONTACT: ❑ OWNER aAPPLICANT ❑ OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: _38c�_GYn�3 <br /> 6ral ldclh tolufa-lam. CONTACT EMAIL: <br /> ACKNOWLEDGEMENT:1 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 I 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 /> PW i6D3-0eq <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />