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�BLIC WORKS PERMI�,PPLICATION
<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
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<br /> ��:� -�`� �=�� � � �� _ � ,�� s�`PROJEC-�T�SITE�INFORMA�T ON` � ����3.r ��� ,��� � z���
<br /> ,
<br /> ���������_�,r�:��,� ��� �:�� -���:��,�.�� .�._.�� ..�.�,uar� _
<br /> PROJECT ADDRESS: �- �'�/"{^r.�,�
<br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, P -APP,SS, ETC.)
<br /> SITE WORK FOR PROJECT TYPE:�SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY RICOMMERCIAL ❑INDUSTRIAL
<br /> CHANGE OF USE? �NO ❑YES, FROM TO
<br /> NEW WATER/SEWER SERVICE NEEDED? �NO ❑YES,TYPE SIZE
<br /> '�.��.���#�q �� ����'-caa�u`�. .•.�3"�.#:�.,:xewamrace uw.�.x y*�. :+F,w.e.a,�e.�a aa,uq�r �+a .•ra ew.-;ws� g�°'s�:id �"-��'���+s�• `,•�� ,���'} t'!f,F���A"����^y'�*ts��gi <��.
<br /> �g��:�.�:�`���������°` SIT K/��G,HT�OFi��;Y�,APPti1C T�O�„� .IN�,O : MATI:ON ;;����������?�, ����` '
<br /> DESCRIPTION OF WORK: r �. m✓'T� �S�'{" TD O
<br /> � r 2. ;' ` 1�. F ou� ° -�e..l�. ,l�- Gw�. o l 1�. �acc. ;w
<br /> e 1 ' ;1�. `' �.s � ' v �` �e l�rj
<br /> ❑ FENCE IN ROW FT IN HEIGHT �� G�l�„r��
<br /> ❑DRNEWAY APRON/CURB CUT FT WIDE
<br /> �ASPHALT/CONGRETE PAVING ?��'j� Sq �T SF
<br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF
<br /> ❑ RETAINING WALL!ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT
<br /> ❑CLEARING/GRADWG/FILL/EXCAVATE CY
<br /> ❑CUTIBORE IN PAVEMENT(PARALLEL) LF
<br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF
<br /> srY ,� 'at:"+i��t�,�} 'F"� ru .-,�*am-n"C '6 . 7 s.-.,` �.� o.;r , ... �, . . �Y n �: sa� .�s rS3�?; t�h._ t p,a s-..c 6 t y e�;�
<br /> <���,. a.���::�,���...:�� ����.� ;..r.�,:��wr�.�M._.s���,��..��.���.,����KCONTACT��GINPORMATION..�,���.���.� � .r, �:.�.Y�.�`.�,� ��,H.�.a:;_.���:"� ,��:��'�`�;'�,.�, � ��
<br /> �:
<br /> OWNER NAME:
<br /> OWNER MAILING ADDRESS: srReer
<br /> CIN STATE � ZIP �
<br /> OWNER PHONE: Q(� p 1 OWNER EMAIL:
<br /> ._...,....w �..�.,..,�._, m,,...�� ,. �...,, k,..,...w�,�. ,,. .,.� ,..wM�,,,..M,,.
<br /> ,,..:,,m ,...wm�, .�__N��m �,,,,�_, _�.�_.w��, Tw.��.,...V.,,� M..,� .,,_.w,�. .,x.�.�.., ....�,�w,,.,w..,_ .,.,.�,. m_,.��
<br /> APPLICANT NAME. �O�w f�c.Y r i S
<br /> APPLICANT MAILING ADDRESS: srrteer L L�d ��' T
<br /> CITY � STATE ZIP
<br /> APPLIGANT PHONE: yj�0 7�-2— �G APPLICANT EMAIL: �o ,�-�-tp 1 �►
<br /> PRIMARY CONTACT: ❑OWNER �PPLICANT ❑OTHER(Architect, Engineer, Etc.)
<br /> CONT CT NAME: CONTACT PHONE: 6� '7 �2� I b �
<br /> �Q�v� �,rri S CONTACT EMAIL: p� �� 2 � � �,�,�� �
<br /> ACKNOWLEDGEMENT�I have reviewed this application and confirm the information contained herein is true and rrecf. Work done pu uant to this permit musf
<br /> comply with currenf 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 O�cial before being authorized under any circumstance.I am the owner,or l am authorized by the owner of this property to
<br /> pertorm the work for which ap ication is made,and I comply with the State Contractors Law 98.27 RCW and 296.200A WAC.
<br /> Cify of Evereft Official Use Only
<br /> PERMIT#
<br /> �. � PW��a�� oa l
<br /> Owner/ u orized Agent Signature Date (Revised 10/92/2095)
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