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���s� ���� ����i� ������s�� <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 /> PIZOJECT SITE IIdFORtVIA7'ION <br /> PROJECT ADDRESS: ���"�j�„� � ��yy� �%�j�� ���.�F . , ��.�,,-��'/.,-.�''!' l � � , G� .._� 1,I <br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:OSFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF UcE? ❑ NO ❑YES, FROM _TO <br /> NEW WATER/SEWER SERVICE NEE�ED? � NO ❑YES,TYPE SIZE <br /> S17E WORK / ROGHT-OF-WAY APPLICATION If�IFORMAI'IOnI <br /> DESCRIPTION OF WORK: �.���� l��C.� /� �"�" � �J�� �����✓ � ✓���'�' ��i��G�i����t . <br /> �-� t /� L_� ` � i�i� �°� 1 � ,L�cF'iln �� <br /> � <br /> ❑ FjFNCE IN ROW FT IN HEIGHT <br /> b�DRIVEWAY APRON/CURB CUT �`�`� FT W1DE <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/F1LL/EXCAVATE CY <br /> ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> �;- I <br /> OWNER NAME: 9'w�. — i� � , <br /> OWNER MAILWG ADDRESS: srREeT � J 2J� �" �—J�'h V �l �r �2�i�� • <br /> - . CITY �����L� STATE � /�,• ZIP � � .j <br /> OWNER PHONE: -'f - �� 2j � � �� OWNER EMAIL: <br /> _ ................ .. ...... . __... ...., - .,_ . ._:�.._. _,_ .. .. <br /> --.. . _- ... _ . , <br /> ___, : .__.. .. <br /> APPLICANT NAME. ���-Jel `.i`� �31�` +`e/'G � ^! � ' �� �� �� �`-� <br /> � � �, -r-;>> , <br /> APPLICANT MAILING ADDRESS: sTReeT �� <br /> CITY �C � �:w-�. � . ��� STATE V' �• ZIP� ll <br /> APPLICANT PHONE: !�o D ���'-�1 ��.I � APPLICANT EMAIL:U1�J�' �� L�t-ML ; _ �,e/�"' <br /> ._ ..,., . __:-.. <br /> PRIMARY CONTACT: ❑ OWNER �APPLICANT ❑ OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: <br /> I � ��' - � <br /> ���� �'J�� � COI�TACT 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 granfing of a permit only authorizes approved work and no deviations therefrom.Deviafions must first be <br /> authorized in writing from fhe Buildrng Official before being authorized under any circumstance.I am the owner, or 1 am aufhorized by the owner of this property to <br /> perform the work fo�which application is made, and 1 comply with the Sfate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � PERMIT# <br /> � ,___� _ �-- q�,S ' �1 PV� �� b�l ����o <br /> � <br /> ---� , , <br /> Owner/Authorized Agent Signature Date (Revised 10/92/2015) <br /> _ .i e <br /> L <br />