Laserfiche WebLink
� � <br /> PU�IL�C �OR�C� �'ER�IiY ,�4PPLi�,�'���� <br /> CITY OF EVERETi'P�RMIT SERVICES <br /> 32D0 CEDAI�STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX�425-257-8857 � (E}everetteps@everetfwa.gov� www.everettwa.gov/permits <br /> . PR4JECT�SITE INFURM.A,T10�- '- . � . . _ <br /> p120JECT ADARESS: w �}�.$!11 p (Lp{� <br /> IF APPI.ICABLE: ❑LAND U5E PROJECT#(SEPA,PRE-APP,5S,ETC.) <br /> 51TE WORK FOR PROJECT TYPE:I�SFR-D�TACHED �SFR-A7TACHED ❑DUPLEX ❑MULTI-FAMILY COMMERCIAL ❑(NDUS7RIAL <br /> CHANGE OF USET NO ❑YES, FROM TO <br /> hfEW WATEFt/SEW�R SERVICE NEEDED? NO ❑YES,TYP� SIZE <br /> � SIT�cWORK I,RIGH�'rOF=WA'1C APP�..ICATIOrI'IrlFORMd�T10N_ , . . . <br /> I <br /> D�SCR1P71oN O�WORK: �'V1 ' G �S' '� - G o� � <br /> v.� r2�s1' d ��2..�.,.�.5" I <br /> ❑FENCE IN ROW �i'IN HEIGHT <br /> �pRNEWAYAPRON/CURB CUT gD FT WIDE � <br /> ❑ASPHAL7I CflNCRE7E PAVING SF � <br /> ❑REiAINI�fG bVEIi.L!ROCK�ttY 1N R)GHT-OF=vVAY Lr I <br /> L7 RETAINING WALL/ROGKERY OVER 4FT'IN HEIG}�(� FT TOTAL HEIGHT ! <br /> C7 CLEARING/GRADING!F1Li./EXCAVATE GY ! <br /> ❑CUTIBORE IN PAVEMEN7(PARALLEL) LF � <br /> I <br /> Cl CU7/BORE IN PAVEMENT{NON-PARALLEL) LF � <br /> , .. . ,- . . . . . - . --... . . - <br /> �OtdTAC'Lr'_INF�RMATION , � - � <br /> , <br /> DWf1ER NAME: �V1�-% �L L SC�-��o i_ �l S TY�►�T c =l 1�-1 �FaN Sv i � <br /> OWNERMAILINGAbpR�SS: srn�� $`i ZS" A�2���'L-T �o1-�t� i <br /> ' �� C=��'�tC" �A,� G� aP Z� I <br /> oiNNER PNONE: �-iZ,s ,� � Z�LZ._ OWNER EMAIL: ST=rrA N S G k c� (�n u4C.IL"[�"c,w;pN� _,�D v ! <br /> - - - - — - - � - - - ! <br /> __. . . _..__ _ __.� .___ _.... ._.._ ,_ ,_..__ . _._... . _ . _..__..�.._,...._ _._. ... .� _ <br /> ApPL1CANT NAINE: SA � S CX.����'�- � <br /> APPI,ICANT MAILIh1G ADARESS: s-nteEr I <br /> GTY STA7E ZIP i <br /> APPLICANT PHONE: APPLtCANT EMAIL: <br /> PRIMARY CONTAC7: ❑OWNER ❑APPLICANT �07HER(Architect,Engineer, Etc.) T � �+- iCrti�-'� <br /> CONTACT NAME: CONTACT PHONE: : �C�1.( C��� <br /> �PcV�[, I'1r�-�S�i�+�. CONTAC7 EMAIL: ' � y/�� � L„ :LC, , <br /> ACKA10W1EDGEMENT.•I have reviewed this applicaflon and confiim tl�o infom�ation contsined herein is truQ end corroct Work done pursuant to fhls permit must <br /> cnmply wrfh current federel,sfate,and local law.The granfing o/a permll only auUrorizes approved work and no devlations thershnm.IJevfaUons musf 6rst be � <br /> authoHzed In wn6ng frnrn the BuUding Olficia!before 6eing authorized under eny ciicumslance.l em the owner,or 1 am authonzed by fha owner of thfs property!o <br /> perfoim the urork for whlch appGcafion ls made,and 1 comply wtfh tho Stato Conf�adors Law 18.27 RCW and 296.200A WAC. <br /> CNy of Everett OfiiGa!Use Only <br /> p�RMrr# <br /> 5 ,5 PW i���s -c�z7 , <br /> Owner/Avthorized Agent Sfgnature Date {Revlsed i0/f?f2015) <br />