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477 PILIC WORKS PERMIT IIIPLICATION
<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 /> ■
<br /> .`;: $IT,E l�J- ^r 'tx ,.'.
<br /> PROJECT ADDRESS: 1720 £U€ / /uriet p tato I3r/&
<br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.)
<br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL
<br /> CHANGE OF USE? )gf.NO 0 YES, FROM TO
<br /> NEW WATER/SEWER SERVICE NEEDED? JIr NO 0 YES,TYPE SIZE
<br /> L4filta
<br /> s. ,• .rv° a, ;'a+� at`e04 �,
<br /> DESCRIPTION OF WORK: eregra6tjet spate_ iitaf au) be- tz4ed 'fly-pelAtie , Copier-1"e:6
<br /> Xtd more_. epeo.t./ learikri eq €4,21A s&aii:y i evirj y crbar_exiek st i ed
<br /> and euerla yr r`r9 to ewe, {crrruve k 1/te__ raidwa y, and mere_ .
<br /> ❑FENCE IN ROW FT IN HEIGHT
<br /> ❑DRIVEWAY APRON/CURB CUT FT WIDE
<br /> ❑ASPHALT/CONCRETE PAVING 'f/Z717 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 /> OWNER NAME: Pori-of Everett
<br /> OWNER MAILING ADDRESS: STREET 120S Crtt#S,n l,) Ltky , Sf tt.' _ Zap
<br /> CITY Everett STATE tom- ZIP q'$2O
<br /> OWNER PHONE: •{ZS 2513It'o OWNER EMAIL:
<br /> ,..,, . uu...vLYs'1x3.., r:..,,.,. ..:,.. :..-,,:.,nf, ..r,::.,:,, :.:.. ..a,�v. ✓„r m. r ...,... ... ,> n..„Er�, v., ,r .. , ..a ,x�4'nFzw.-, c:,r..:.s.v,
<br /> APPLICANT NAME: s(LZJtddrl Wh j bake
<br /> APPLICANT MAILING ADDRESS: STREET yte_ 44 OWrte.r
<br /> CITY STATE ZIP
<br /> APPLICANT PHONE: 'fZS 4 Fj cx t APPLICANT EMAILf kper
<br /> PRIMARY CONTACT: 0 OWNER SKAPPLICANT 0 OTHER(Architect, Engineer, Etc.)
<br /> CONTACT NAME: CONTACT PHONE: las 3eFl-GYD,3
<br /> 6ret ndnrt CONTACT EMAIL: kiwkiyaleee_gpeervarevefeitcorn
<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 /> 131M4: Z.-let-ICe PW 1 o3-D
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
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