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�► PLA_IC WORKS PERMIT /APPLICATION
<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 www.everettwa.gov/permits
<br /> r§ - ,� _ PROJCTySiTE;TNPORMATION ;
<br /> PROJECT ADDRESS: 4--//3,Z Fr peo c (J-€ f [!11E-Re:jj Uni %2 3
<br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.)
<br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX 0 MULTI-FAMILY ❑COMMERCIAL El INDUSTRIAL
<br /> CHANGE OF USE? 0 NO 0 YES, FROM TO
<br /> NEW WATER/SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE
<br /> ..:i �'�f �..FiE ee`t -�rtz�i t..�g'�r,�r��:. a :.;..�a ','x ,c,._;, ,.�_ a. .� a�'" n *.:.�' w s,: x�.� r a �.-� a: 4 `�^,'
<br /> ,.r: SITE WO K/t RIGHT OF WAXF n PPLICa titifi NFdOWTJON ; � FzA
<br /> x•:.;r3.a� ,,,.;..,..u�.x ra-.,::.'S �....:a;:.,, .r5-�.,.ns;.,✓�v.r.�.a:..7 � J .�!•F�r!�e•.r,.w.H.'k., �..,;a, ....-_,...mx.v
<br /> DESCRIPTION OF WORK: 2.6 STA/ P/i'.f6 G--C/ 57-?Ai P i'iJ f> 7
<br /> 4if 712-1 ' C ue -- 4)6.724j 4-5 R'N.4u
<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 /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT
<br /> ❑CLEARING/GRADING/FILL/EXCAVATE CY <U"lJ iy1
<br /> IANJ'i12
<br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF
<br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF 1/ Dq () 1
<br /> io
<br /> "^3 1 i, V ,<`� is it f z" z rt iCO - �. K': z , i' > { :gs,:
<br /> �,. E =f.' >„ NTACT�INFORMATION� ; .� �;,_�
<br /> OWNER NAME: 5'&7/WU'7f 7)fri V€+t/'TI S etGI/2,CY'/
<br /> OWNER MAILING ADDRESS: STREET 517 g r�^( 't2f}L. /4f/s- /�
<br /> CITY a V 2-7/ STATE WIC ZIP CiOao
<br /> OWNER PHONE Lt2c.ZS2 -�c43 _, w OWNER EMAIL: 6)2 F'2,4 ... pA 1,,RcIJ 1j-.ie sl e,—/-
<br /> APPLICANT
<br /> ,APPLICANT NAME: j` L�� M v9A1'46E'<
<br /> APPLICANT MAILING ADDRESS: STREET 1/?.2FGe- c .4 br
<br /> CITY Fik- /7 STATE /^�/� ZIP q9
<br /> Z63
<br /> APPLICANT PHONE: qZs 2,©—1q09 APPLICANT EMAIL: pi j 5—tete.-fitter,C ea* VI--
<br /> _
<br /> PRIMARY CONTACT: 0 OWNER APPLICANT ❑OTHER(Architect, Engineer, Etc.)
<br /> CONTACT NAME: CONTACT PHONE: 42 ale, r----(q69
<br /> C/OGf c/Al CONTACT EMAIL: kyi i 44er°' Wt G4.-c --i1"0 kTIl,4
<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 /> City of Everett Official Use Only
<br /> PERMIT#
<br /> 0/ , CX/i, 7 PW not-f -o2-
<br /> •wner/Authorized Agent Signature Date (Revised 10/12/2015)
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