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Pl-IC WORKS PERMIT �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
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<br /> £ �`4 4 �`�.�' � .. *��,`., �� :.< 6 y, � u� `a`'�'��`,`��'"`'� �, 'T§ �7�� �� .
<br /> �;�� � ,�� � � � �. �� � R`OJE���TE�INFORM�ATIONa' ��� ��:�.�����,���.,�.�`'�����.,-��_:.����
<br /> >N.�..�.7��. �� � � �.�;�� :..�,�. .,�,
<br /> PROJECT ADDRESS: 5� �
<br /> IF APPLICABLE: ❑ LAND USE PROJECT#�(SEPA,PRE-APP,SS, ETC.)
<br /> SITE WORK FOR PROJECT TYPE:�SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL
<br /> CHANGE OF USE? ❑ NO ❑YES, FROM TO
<br /> NEW WATER/SEWER SERVICE NEEDED? ❑ NO ❑YES,TYPE SIZE
<br /> �+� �'�.-c7�'�e�=t.,�,�,'�.'��� �s;;..�yyC'?�""'.�.��:Y�' ... �,w� �a�w�:u�_p«ea..,�,*ti�f�cv�p��ws+',�n ..s a��..-af� t..,w,', �x�;� q�z�'��u�..� ,x:�wK��af �s �, . "���x�. `���'�i a ��
<br /> :�������t'��,�.�����.�#�,��s��.'� S'1T� WO -K.�R��l' OF-�1iiVAY�,A�„PP�LICATt10 1!N�OR �TION -�����������:���� . ��
<br /> .�
<br /> DESCRIPTION OF WORK:
<br /> ❑ FENCE IN ROW FT IN HEIGHT
<br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE
<br /> ❑ASPHALT/CONCRETE PAVING SF
<br /> �� � � ��k�� �
<br /> �RETAINING WALL/ROCKERY iN RIGHT-OF-WAY �2 �� ��� �° t�.M,
<br /> � �:,.,._ a
<br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT �
<br /> ❑CLEARING/GRADING/FILL/EXCAVATE CY • ��� � $ ��1� �
<br /> �
<br /> ❑CUT/BORE IN PAVEM�NT(PARALLEL) LF ����' ,�� ���������
<br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF �'�.'6'�'1i� ����3��=��
<br /> t<w �.. �..,. .s .� ,,,_ ... .. ^r � � 3 r �-�s t`r�.�" ��� s i_*r`.
<br /> �} �� �' ` �� ' > �, �CONTACT INFORM/►TION � ���� 4 �~� � ` �' '�� > � � �
<br /> !w`�'�Yx�.aa.�.:�, i.�,..t.:< ,.��,.t. 1,�,�,.�..,d?,��*�,,,.,e,w.,�„�,� ."s;� ,.,i�7. ,.�'���. t�i..4�Yz�.�,m.-e�:�..�.?�w a�.�.u�.,xoh a, -,� �.s��,�..;� . ; ta,,,....�,v'�.'� „n�ik,.,.�:xx., He.iw,, a,�e,.�,r��, .r:�'M�,�.k_.�,.,m�
<br /> OWNER NAME: J�� � C -� ,�' ��S 2 S C t�o x.Cc✓►✓tE� '
<br /> OWNER MAILING"ADDRESS: sTReer Q. p, �oX ��{6 S
<br /> CIN r—`1� KI�L.T�O STATE W� ZIP 9���
<br /> OWNER PHONE: �}2S -`d`7( - i ( OWNER EMAIL: E�i�a w o o� Cc,h O a - �.o
<br /> APPLICANT NAME: S Cn e Cc S Ct.I�O✓ 2
<br /> APPLICANT MAILING ADDRESS: s-rReer C'�l`� (�S CO�'"IC/}S%r/11,G'i/
<br /> CIN STATE ZIP
<br /> APPLICANT PHONE: EMAIL:
<br /> PRIMARY CONTACT: I�(OWNER y�APPLICANT ❑OTHER(Architect, Engineer, Etc.)
<br /> CONTACT NAME: CONTACT PHONE: t.�.Z S —S 7�o � 3 I 1
<br /> �Oka hYl� ��-�ri e v� CONTACT EMAIL: E L�o �- �p� c�.�ap.CO
<br /> ACKNOWLEDGEMENT.�I have reviewed this application and confirm the informafion contained herein is true and correct Work done pursuant to this permit must
<br /> comply with current federal,stafe,and local law. The granfing of a permif only authorizes approved work and no deviations therefrom.Deviafions musf first be
<br /> authorized in writing from the Building O�cia/before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to
<br /> perform the work for which applicafion is made,and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> ' � � Z3 ,� PW ��`� �' ��d �-v
<br /> Ow r/Authorized Agent Signature Date (Revised 10/92/2015)
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