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<br /> "-.1; LIC WORKS PERMIT II PLICATION
<br /> Nits CITY OF EVERETT PERMIT l-II� ICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> PROJECT SITE INFORMATION ,
<br /> PROJECT ADDRESS: 2,3 'f l/LJ}I\lb b
<br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.)
<br /> SITE WORK FOR PROJECT TYPE:DSFR-DETACHED DSFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL
<br /> CHANGE OF USE? D NO D YES, FROM TO
<br /> NEW WATER/SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE
<br /> _ ,; SITE W,O,RKKI,RI,GH'I. OF WAY APPILICATIONINFORMATION _,. ..,:_h
<br /> DESCRIPTION OF WORK: Ozns- Uc-7 O r) Mb f to 1 1-1, P-eC-P__
<br /> D FENCE IN ROW FT IN HEIGHT
<br /> D DRIVEWAY APRON/CURB CUT FT WIDE
<br /> 0 ASPHALT/CONCRETE PAVING SF
<br /> D RETAINING WALL/ROCKERY IN RIGHT-OF-WAY . LF
<br /> D RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT
<br /> `IQ CLEARING/GRADING/FILL/EXCAVATE / O} CY
<br /> D CUT/BORE IN PAVEMENT(PARALLEL) LF
<br /> D CUT/BORE IN PAVEMENT(NON-PARALLEL) LF
<br /> CONTACT.INFORMATION
<br /> OWNER NAME: JOSE P -1 -tow Keit)
<br /> OWNER MAILING ADDRESS: STREET 23? /&, ,A I.
<br /> Crn, ej UaeYr STATE OA ZIP 9goO3
<br /> OWNER PHONE: OWNER EMAIL:
<br /> », ..t..werce, Ww.rt; M, ...w, ,..., 1 , .,,..,._,.M. .. m.Y..__.. .,....,.,w, .w..,M.M- ,,,.m,.,wTM,_s„r m.»�,, .,.M.<.-.,M.,.,.. ..w,..m.,.�.,,
<br /> APPLICANT NAME: /�� J�)J7"7 7`!�'�.
<br /> APPLICANT MAILING ADDRESS: STREE
<br /> CIW STATE ZIP
<br /> APPLICANT PHONE: APPLICANT EMAIL:
<br /> PRIMARY CONTACT: 0 OWNER AAPPLICANT 0 OTHER(Architect, Engineer,Eta)
<br /> CO CT NAME: :;:::
<br /> 4 g-7&::, - /7 6
<br /> , G � `� X �
<br /> ACKNOWLEDGEMENT•I ave 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 tam 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 /> � ��/ �� 1 V1l/6 .9' --
<br /> 4*/
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
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