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P■ LIC WOF�KS PERMIT � �'LICATIOtV
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<br /> - - - CITY OF EVERETT PERMIT SERVICES
<br /> 320� CEDAR STREET, EVERETT, WA 98201 �
<br /> (P)425-257,-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.go�� www.everettwa.gov/permits
<br /> � � � ,� k,�� 3 � � � p ,�� � � M �-� _ � �
<br /> ,� � � � � s : PR�JECT SITE IN�('��IN�A'TION���'' � , ��
<br /> e� �.. ��� a M�. ������. �� � .��.�..-�., � ��.���:.: ,. ,_�
<br /> PROJECT ADDRESS: / / � _ �� r�j/1/� 9p Z�O
<br /> IF APPLtCABLE: ❑LAND USE PROJECT#{SEPA, PRE-APP,SS, ETC.)
<br /> SITE WORK FOR PROJECT TYPE:OSFR-DETACHED, , ❑SFR-ATTACHED ❑DUPLEX, �MULTI-FAMILY ❑COMMERCIAL< �INDUSTRIAL
<br /> , . � :� , _ �
<br /> CHANGE OF USE? �NO ❑YES, FROM TO .
<br /> NEW WATER!SEWER SERVICE NEEDED? NO ❑YES,TYPE SIZE
<br /> w < � . � s�, � �, � ,� � �.�,�,�AwPPL¢ � � r 4�
<br /> _ . � �SMTE WORK/ R,IGHT OF 1ME#Y� 41 OR;M O
<br /> , _,�,. ., � .N� .� _.._ � .�,u� , u, ,,. .. �_� ,.. .., �� , T��,
<br /> C�pT� N INF N
<br /> _ ._.. _.:._,. _ . .. . � .,_ �_.�., �.,. t.
<br /> � _ "
<br /> DESCRIPTIOIV'OF WORK: �f�(�,d'` � �����-�— �/" 3I�-� �f F1' Q l�'�'~
<br /> �
<br /> . 1'S�t o%� �"%e �-w�- �� vbi� -�r- �a�-� d'r91`�-_
<br /> �l.r'�f ���? . �a' . -�w�.-�� �tst- �1ar,��.. d�v�.-�s-- iS" ��'� �+r�..�-�Ct-�(� 1%to+��2,
<br /> ❑ FENCE 1N ROW FT IN HEIGHT
<br /> ❑DRIVEWAY APRON/GURB CUT FT WIDE
<br /> �ASRHALT/GONCRETE PAVING `���, ' SF
<br /> ❑RETAINING WALL/ROCKERYJN RIGHT-OF-WAY LF ,
<br /> ❑ RETAINING WALL'/ROCKERY OVER 4FT`IN HEIGHT FT TOTAL HEIGHT
<br /> ❑ CLEARINGI GRADING/FILL/EXCAVATE CY
<br /> ❑CUT/BORE IN PAVEMENT{PARALLEL) ' • LF
<br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF
<br /> ':,.; , . . ...... ~
<br /> ; CONTACT��N�ORMATION
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<br /> OWNER NAME• �l�-d�lc�� p V
<br /> OWNER MAILING ADDRESS: s-rRee-r ���, '�j f��h �-�" t/1�/
<br /> CITY �� STATE ZIP ��
<br /> OWNER PHONE: �� `��- ���`� OWNER EMAIL: ������, ri�.}i�. G�i�'e.
<br /> APPLICANT NAME: ('l��//� -
<br /> �
<br /> APRLICANT MAILING ADDRESS: srReer
<br /> .� . � � .. . � � �� � CIT1' . � . � . . � . .. � .. .��STATE . � � . . ZIP �� . .. �
<br /> APPLICANT PHONE: APPLICANT EMAIL:
<br /> PRIMARY CONTACT: OWNER ❑APPLICANT ❑OTHER(Architect,Engineer, Etc.)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> ACKNOWLEDGEMENT.�I have reviewed this application and confirm the information contained herein is true and correct Work done pursuanf 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 fhe Building Official before being authorized under any circumstance.I am the owner,or!am authorized by the owner of this property to
<br /> perform the work for which application is made,and 1 comply with the State Contractors Law 98.27 RCW and 296.200A WAC.
<br /> City of Evereft Official Use Only
<br /> PERMIT#
<br /> � ��+ �� PW � 6��- - �d6 4
<br /> Owner/Authorized Agent Signature Date (Revised,10/12/2095)
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