Laserfiche WebLink
������ ���� ��� �� ������p�� <br /> C1TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 9820'1 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) eueretteps@everefitwwa.gov � www.everettwa.gov/permits <br /> _ _ <br /> , . ,.. , . <br /> ,-,: _. .. � <. <br /> - . <br /> _ , ; .PROJ��"P SI`1"E II�IFOR114�A`tlOt�: < - <br /> -.. :;.. ..._: r.. , .. ... ._ _ <br /> PROJECT ADDRESS: ��I 1 <br /> ►F APPLICABLE: ❑ LAND USE PROJE #(SEPA, PRE APP,SS, ETC.) <br /> SITE WORK FOR PROJECT 7YPE'�SFR-DETACHED ❑SFR-ATTACHED CIDUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? D3�(NO ❑YES, FROM T� - _ <br /> NEW WA'TER 1 SEWER SERVICE NEEaED? ❑ NO �YES,TYPE��e� V�LP � SIZE I �� <br /> . .. <br /> .. . .. . .._ __. . <br /> . ' . S17°E WARIC� �tlGl°!'i'-OF lll/,�►1(APP'L.IIG�,�'1AN'1I�FORMA'�'IOId <br /> DESCRIPTIOIV OF WORK: � `*" � <br /> ❑ FENCE IN ROW FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> ❑ASPHALT/CONCRETE PAVING SF <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> C3 RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT F'T'TOTAL HEIGHT <br /> ❑CLEARING/GRADING/F1LL/EXCAVATE CY <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑ CUTIBORE IN PAVEMENT(N�N-PARALLEL) LF <br /> . . ... . ., . _ .. <br /> _. <br /> . . .. _ . <br /> . <br /> . ` ` `' CANTACT I:NFORMATION _ . <br /> OWNER NAME• <br /> OWNER MA►LING ADDRESS: STREET "1-i �-+ � <br /> CIT1' STATE ZIP <br /> OWNER PHONE: " "' �� OWiVER EMAIL: <br /> APPLICANT IVAME: <br /> APPLICANT MAILING ADDRE S STREET � � <br /> CI7Y STATE ZIP� <br /> � , ' � <br /> APPLICANT PHONE: APPLICANT EN(AIL: Cj <br /> ��..�...�9,��_.�..�<M,�,�..�,��,.�.,,w�>...:�:.. .:,.��...�..�..,.�...a. a_: .,�..,,.,,.�...,.�_...�.y_. <br /> PRIMARY COfVTACT: ❑ OWNER �1 APPLICANT ❑OTHER(Archifect, Engineer,Etc.) <br /> CONTACT NAME: C'3 COfVTACT PHOAIE: L f`�,�j �� �6� '�Q�p �Gj <br /> ��� CONTACT EM�IL: �`��/� • <br /> ACKNOWLEDGEMENT.�l have reviewed this application and confirm the information contained herein is tr e and correct' or n pursuant to this permit must <br /> comply with current federal,state,and local law.The granting of a permit only aufhorizes approved work and no deviations erefro .Deviations must first be <br /> authorized in writing from the Building Official before being authorized under any circumstance.I am fhe owner,or I am authorized by the owner of this properfy to <br /> perform the work for wi�ich application is made,and I comply with the State Contractors taw 98.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> PERM(T# <br /> ��� _ ��I I'� 12�6� 1 <br /> Owner/Authorized A_, ntSignafure Date (Revised 90/92/2095) <br />