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, � <br /> PI.�IC WORKS PERMIT A�'LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECTADDRESS: (U���% 1����1� �iIZUT1�i�=�'`(� �/�Tl�'l.� <br /> IF APPLICABLE: , LAND USE PROJECT#�SEPA PRE-APP, SS, ETC.) �i� � !!:' <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ,�LCOMMERCIAL ❑INDUSTRIAL <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: ��C D\f�(i �SL t,`�' �1 l�L - � <br /> -X. 1��O D F ,� . � � C 1 ' C �`l`1��: S ", " 'T�l <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: (��1�-C tT (.`��I ���L�l,�l 1 C'�L�=Lc �� <br /> OWNER MAILING ADDRESS: srRee-r ��C'�-� �WGr�— ��.� <br /> CITY �f/�` �� STATE ��� ZIP 1 � �`-'I <br /> OWNER PHONE: ��^2i�'����i I Iv OWNER EMAIL: J�U'�IW�C��-I Gv �L�'1,�2�LL.- ��� <br /> APPLICANT NAME: j�`�{.�l�l'�1�'i�" �(/�6�'�{'� <br /> APPLICANT MAILING ADDRESS: srReeT I � � �I� (Cf�1 Sl�'-�'T SV1.�'� 7V�% <br /> CITY �I ' ' 'vv STATE L�v� ZIP � C.� � v I <br /> APPLICANT PHONE: 2-�F�� ?�-' l���i APPLICANT EMAIL: �,�1 b�-/-��J{-I �^' S�� �/�'��T(�1��N�I P' CU�� <br /> PRIMARY CONTACT: ❑OWNER APPLICANT ❑ OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: <br /> �1��� t���I�' �?U� 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 1 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 /> �--- ���� ---Z--� �, P W ��� � -�9�� <br /> �� � � ��� `�i� <br /> Owner/Aufhoriz�. gent Signature Date (Revised 10/12/2015) <br /> L..__- ' <br />