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PL_M-IC WORKS PERMIT ArPLICATION <br /> I�►' - - 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 /> PROJECT SITE INFORMATION <br /> _oma ... .� v__r. .. ... .. �_... . _ <br /> PROJECT ADDRESS: 3102 t L& J a r c WI; WA -t K <br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPESFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? ----a NO ❑YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? NO 0 YES,TYPE SIZE <br /> SITE WORK.,/.RIGHT OF-WAY APPLICATION INFORMATION <br /> (� <br /> DESCRIPTION OF WORK: Cl\k� e � 'Qnn C,e� 01/4C4Um t�r 3'G^tent y <br /> 14 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 /> 0 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: fl.c ity �U� �A(—Mk. I <br /> OWNER MAILING ADDRESS: STREET .4.2z.9 I G AAr�1 V��Ol / (y1 4A' {O l/ � <br /> 1 _C CITY STATE N A ZIP O 9_41 <br /> OWNER PHONE ;Z . -2,1 , OWNER EMAIL: <br /> ��. ��._...3j��( ..��._w s�...k..<..s.%...�,.ff�. ..�w�.�..,.kw.Mm .,, .,._��.�... w�.M.._.......:..v� .:..,, ... n. �....�.v .�._..�K.. <br /> APPLICANT NAME: `Z-i 0,1\(kt(v z 'Fi\\oU\Cri\kkc.,��' <br /> APPLICANT MAILING ADDRESS: STREET .� Qt a„ ,..-k ALA_ I ALA° L/ <br /> \ <br /> cr �CITY k STATE 61\1A <br /> l 1 1 ZIP <br /> APPLICANT PHONED 2C.?t ' ,�, K. -_,� _ .._..APPLICANT EMAIL: �... x.. N <.. .n,,_ ..rw ., ., . _,, ,, . <br /> PRIMARY CONTACT: 0 OWNER 'APPLICANT 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: [,I e 1-1L4 '31 G, <br /> 4.4 n a r u 6•160tA rOOkic 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 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.lam 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 /> ''7/67PE <br /> 1 W <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />