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477- PDLLIC WORKS PERMIT AISLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 812 35th Street, Everett <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:DSFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX DMULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? IR NO 0 YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? II NO 0 YES,TYPE SIZE <br /> SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: Removal of yard waste debris pile from gully bank,hydro seeding of any areas <br /> disturbed or devoid of vegitation. <br /> 0 FENCE IN ROW FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> ❑ASPHALT/CONCRETE PAVING SF <br /> 0 RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> 0 RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT 5/3/20/0 <br /> /3/2G0 (fJ o, " <br /> El CLEARING/GRADING/FILL/EXCAVATE CY / <br /> ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> 0 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: Sanford Wright <br /> OWNER MAILING ADDRESS: STREET 2320 Rucker <br /> c,,, Everett STATE WA ZIP 98201 <br /> OWNER PHONE: OWNER EMAIL: <br /> APPLICANT NAME: same as above <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: 0 OWNER 0 APPLICANT 20 OTHER(Architect, Engineer, Etc.) attorney <br /> CONTACT NAME: David Carson CONTACT PHONE: 425-493-5000 <br /> CONTACT EMAIL: david@carsonlawgroup.com <br /> ACKNOWLEDGEMENT:I 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. 1 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 /> t- ` /2.G(6 PW1605 -007- <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />