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OLT PL LIC WORKS PERMIT I'LICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRE S:' 6/ _H ii,g J�_ JM.� Loop _6/ - k 1-6 Pv04,1T
<br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-_APP,SS, ETC.)
<br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX OMULTI-FAMILY *COMMERCIAL DINDUSTRIAL
<br /> CHANGE OF USE? ,NO 0 YES, FROM TO
<br /> NEW WATER/SEWER SERVICE NEEDED? ❑NO ❑YES,TYPE SIZE
<br /> DESCRIPTION OF WORK: 71ce_ ltbrf-QQ F' ,/ he-mom( _���tC ( FIQ20tLde,- 13cA.d
<br /> t3a)cca r / -(ci 4 p2rf e� i 4 GI. iV f r6rr#-P(a&.e Ceuira, red— eft:10"m T/ua proJesa�-uzGl ./
<br /> . oge-li Q?.ett/ n'wwi/e budetchd acr+ol p11.G2 on etc, item4) 7f1crt.ndodlcf1.
<br /> ❑ FENCE IN ROW FT IN HEIGHT T_ stets to �/�/noj
<br /> ❑DRIVEWAY APRON/CURB CUT FT WIDE biof1J„,„ d .£` n Qc7(
<br /> 0 ASPHALT/CONCRETE PAVING SF Vg4gve,hatfrt
<br /> <9a4—
<br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF 1 icc
<br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT 2,30 *- 17 a�15
<br /> J$iCLEARING/GRADING/FILL/EXCAVATE (4-e-is CY 1 rail
<br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF
<br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF
<br /> "CONTACT INFORMATION
<br /> OWNER NAME: tip of Everett-
<br /> OWNER
<br /> veFettOWNER MAILING ADDRESS: STREET j 266 C-rztq#Srvta rl " T f 2 2 °
<br /> CITY � T STATE WA ZIP Q$2-01
<br /> OWNER PHONE: /2S-2S1-3/( / OWNER EMAIL:
<br /> u�W
<br /> APPLICANT NAME: arCUtdDY) cotazzicer
<br /> APPLICANT MAILING ADDRESS: STREET .ate- ad at)tt.P2r
<br /> CITY STATE ZIP
<br /> APPLICANT PHONE: 4f2S-3F8- (3 APPLICANT EMAIL: �'lwitibz�r� o eMC
<br /> PRIMARY CONTACT: 0 OWNER JZAPPLICANT 0 OTHER(Architect, Engineer, Etc.)
<br /> CONTACT NAME: isrez,ider, o'tf> r CONTACT PHONE: tfZS-3e8-,:56,13
<br /> CONTACT EMAIL: bwitif>l.Mer7e0ar-tafeverlt-cam
<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 l 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 /> PW � 403- 466
<br /> 3-Y-/Cc
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
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