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PLALIC WORKS PERMIT APPLICATION__Ahrr <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 /> T PROJECT SITE/INFORMATIONS „ j <br /> PROJECT ADDRESS: ,;,90117 O rotN <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:CFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY ❑COMMERCIAL 0 INDUSTRIAL <br /> CHANGE OF USE? '1;i(NO ❑YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? <br /> NO ❑YES,TYPE SIZE <br /> <, ri SITE �OikkAI"GHT-OF=WAY APPLICATION IYC OrMATION�" <br /> .-.f,« i' < i,..n.....s'�"+.2'r�,'.� �:2<„w`iT�raM }�4.'�sx�s3.Ets;'.`F�:�''�5 "a�a'eta^�'��5c�i,s�l...�.�-.....-<r:�sr'#.s,^.3��;:�a:• +t:� 'ie �:sasE�#-�`'`,.w`.tt.a�%23.zY-s4�Ft .Xk#�P:�:: �t'neK1�:�ln.aE;,. ,.<,.:1, .n...,o-<:y`.i. <br /> DESCRIPTION OF WORK: 5 i k. a_k_a-eaL,ticyjevr c.e_ <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 <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: N c'I 6C4 <br /> OWNER MAILING ADDRESS: <br /> c",/7 STREET C✓ /)J -7 C /Q ,4 (, k / /,[/j`� f <br /> -68 -941 -��3 CJ CITY 1 L C�( C STATE W / , ZIP �eV`V ` <br /> OWNER PHONE: IA7 y� OWNER EMAIL: b aid!I .5 C `� C UVI�1C: G�5 °..�( e V <br /> APPLICANT NAME: f'ty` i a; 6 C/ O t <br /> APPLICANT MAILING ADDRESS: STREET GLN d A <br /> CITY Q< L STATE (O 74 ZIP 18',Q D( <br /> APPLICANT PHONELIZ0 3 APPLICANT EMAIL:MQ,)(1,1' (_„(� CO -+ / l <br /> `��..n. .�....�7 .�. .,..:_ �.-_�,.���.�.�.�....,�...�.,,...a �f.U.y�.rv...._, �.� M C_115�...::.A ..r.�.. <br /> PRIMARY CONTACT: I OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) <br /> t <br /> CONTACT PHONE: -( <br /> CONTACT NAME: 4�5 e-f q ( 0 <br /> (d IcotTCONTACT EMAIL: h e f U.1 S L 1 () Ci L�'1M C(Q�f iJe <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 /> Goat,p..L� D.i <br /> 't,1 &P f &- o c B l Hai City of Everett Official Use Only <br /> D DO .r- La 1411; <br /> / / PERMIT# <br /> PW ( ;-o(-4 - a.3Z <br /> Oner/Authorized Agent Signature Date (Revised 10/12/2015) <br />