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���'� Bel���� ������ 1������ 9 ��� <br /> C1TY 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 <br /> PROJECT SITE IIdFORNa�iTION <br /> PROJECT ADDRESS: L J / � G a yi� %I �'��� <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 /> I�EW WATER/SEWER SERVICE NEEDED? ❑ NO ❑YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> / � ' <br /> DESCRIPTION OF WORK: `�J c-/c'� � J{/S f%•'� c'�.' ' ✓ � �c �--'J v�/Y/� <br /> L� .J G,.'J�� J�; 5 E �!// f�i <� C "�9 C:c�f C 'C�'�"i c �� > Gi .. �c-c C <br /> CCsGr:SfY'(.��7 ic�Vl ���G0�7S <br /> ❑ FENCE IN ROW FT IN HEIGHT f�� ' .� <br /> DRNEWAYAPRON/CURB CUT � i���,y� -}'n `z�% -�' . FT WIDE <br /> ❑ASPHALT/CONCRETE 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 CY <br /> ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: � ���� J��. 7� <br /> OWNER MAILING ADDRESS: srREer � 3/ 7 L.� i✓� �� `��� <br /> / �O ' -' <br /> CITY � !/� /�� � STATE `�c��� `y.. ZIP L �/ s <br /> OWNER PHONE: - ��Z S ��� �` 1� OWNER EMAIL: S %�c= d'r'/ S `7� �� ��-i �/ �. C✓ /Li <br /> APPLICANT NAME: � C:( V✓�� <br /> APPLICANT MAILING ADDRESS: sTReeT <br /> CITY S ATE Z�P <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: ❑ OWNER ❑APPLICANT ❑ OTHER(Architect, Engineer, tc. <br /> CONTA�NAME: CONTACT PHONE: <br /> ' c=,;i � S.3� f S CONTACT EMAIL: <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 autho�izes approved work and no deviations therefrom.Deviations must first 6e <br /> authorized in writing from the Building Official before being authorized under any circumstance.1 am the owner,or I am authorized by the owner of this property to <br /> perform the work for whrch application is made, and I comply wifh the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Officral Use Only <br /> PERMIT# <br /> 1 !/ V <br /> Owner/Authorized Agent Signature Date (Revised 90/12/2095) <br />