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. � �� <br /> . � � Lec w��.�cs ���nn��rA���'��-rio�v <br /> CITY OF EVERETT PERMIT SERV[CES <br /> 3200 CEDAR STREET, EVERETT, WA 98209 <br /> (P)425�257-8810 � FAX 425-257-8857 ((E) everefteps@everettwa.gov � www.everettwa.govLpermits <br /> , , , . ,. � . <br /> ' PROJEC7`SITE 1NFORMATION ` <br /> �� . _,.;�_. �::� _. .��: ��_ �_ � ... _, :�����,�,._ .h _...-. . � ., ..__ _ - - <br /> PROJECTADDRESS:, `� � (/{�iY� �� <br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> SITE WORK FOf2 PROJECT TYPE:�SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? NO ❑YES, FROI�/I TO - <br /> NEW WATER 1 SEWER SERVICE NEE�ED? �NO ❑YES,TYPE SIZE <br /> SITE WORK,1 RIGHT OF.=WAY:.APPLICATION 1NFORMATIVON ' <br /> , _.. .. .. . : ... . .. ._� _ ,. .. <br /> DESCRIPTION OF WORK: C Y't!Q' W QLC Q`'�h �� S r <br /> ❑ FENCE IN ROW FT'IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> �ASPHALT/GONCRETE PAVING SF <br /> RETAINING WALL/ROCKERY IN RIGHT-OF-WAY __�(� LF <br /> � RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> ❑CLEARING/GRADING/FILL/EXCAVATE GY <br /> ❑ CUT160RE 1N PAVEMENT(PARALLEL) LF <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> _ . ; ., . , . •; <br /> CONTACT INFORMATION <br /> OWNER NAME: �•t. �e,'�ea.' <br /> OWNER MAILING ADDRESS: srReer v �. '�f <br /> CIN �V�j�'G STATE ZIP <br /> OWNER PHONE• �;53 Z�� 8 g�'o OWNER EMAIL: alezaive'� �Cv�n _ <br /> APPLICANT*NAME: S Yy}-6 <br /> APPLICANT MAILING ADDRESS: sTReer <br /> CIIY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: ❑_OWNER`��APPLICANT ❑OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME; CONTACT PHONE: <br /> COPITACT EMAIL: <br /> ACKNOWLEDGEMENT.�l 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 granfing of a permif 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.!am fhe owner,or I am authorized by the owner of this property fo <br /> perform the work for which application is made,and l comply with the Sfate Contractors Law 98_27 RCW and296.200A WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT# <br /> � yl � � �W ���--. o�� <br /> OwnerlAuthorized Agent i nature Date (Revised 10/92/2095) <br />