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PIOLIC WORKS PERMIT 41PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 10611 EVERGREEN WAY <br /> IF APPLICABLE: O LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: O SFR-DETACHED =SFR-ATTACHED O DUPLEX O MULTI-FAMILY O COMMERCIAL <br /> CHANGE OF USE? O NO O YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? I NO O YES,TYPE SIZE <br /> SITE WORK I RIG( �P-WAWAPPLI I <br /> ...,..,. �. .„,, ..ya • " <br /> DESCRIPTION OF WORK: SITE WORK FOR ADDITIONS TO SHOWROOM &SERVICE BAY <br /> O FENCE IN ROW FT IN HEIGHT <br /> O DRIVEWAY APRON/CURB CUT FT WIDE <br /> =ASPHALT/CONCRETE PAVING SF <br /> O RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> O RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> O CLEARING/GRADING/FILL/EXCAVATE CY <br /> IO CUT/BORE IN PAVEMENT(PARALLEL) _LF <br /> n CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> OWNER NAME: S R KLEIN FISH-ON INVESTMENTS LLC <br /> OWNER MAILING ADDRESS: STREET PO BOX 3830 <br /> crry EVERETT STATE WA ZIP 98213 <br /> OWNER PHONE: (OWNER EMAIL: <br /> APPLICANT NAME: fAppNamel <br /> APPLICANT MAILING ADDRESS: STREET [AppAdd] <br /> cr r [AppCi] STATE [AppSt] ZIP [AppZip] <br /> 1 APPLICANT PHONE: [AppPhone] (APPLICANT EMAIL: [AppEmail] <br /> PRIMARY CONTACT: O OWNER O APPLICANT O OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: [ContactName] CONTACT PHONE: [ContactPhone] <br /> CONTACT EMAIL: [ContactEmail] <br /> ACKNOWLEDGEMENT I 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 granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be <br /> authorized in writing from the Building Official 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 application is made, and i comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> L I-,,�[(1T City of Everett Official Use Only <br /> PERMIT# <br /> PW 1711-029 <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br />