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477 PIC WORKS PERMIT VILICATION <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.govj www.everettwa.gov/permits <br /> - PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:9407 SHARON DR <br /> IF APPLICABLE: O LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: OSFR-DETACHED O SFR-ATTACHED O DUPLEX O MULTI-FAMILY O COMMERCIAL <br /> CHANGE OF USE? O NO O YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? O NO O YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: SITE WORK FOR DRIVEWAY& NEW DETACHED GARAGE <br /> O FENCE IN ROW FT IN HEIGHT <br /> I= DRIVEWAY APRON/CURB CUT FT WIDE <br /> I (ASPHALT/CONCRETE PAVING d .q" " SF <br /> O RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> O RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> O CLEARING/GRADING/FILL/EXCAVATE CY <br /> O CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> O CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: URRUTIA-MENCHACA ASUZENA <br /> OWNER MAILING ADDRESS: STREET 9407 SHARON DR <br /> cm' EVERETT STATE WA ZIP 98204-2647 <br /> OWNER PHONE:4257504048 (OWNER EMAIL: <br /> APPLICANT NAME: IAprNamel <br /> APPLICANT MAILING ADDRESS: STREET [AppAdd] <br /> crry [AppCi] STATE [AppSt] ZIP [AppZip] <br /> APPLICANT PHONE: [AppPhone] 'APPLICANT EMAIL: [AppEmail] <br /> PRIMARY CONTACT: ZOWNER O APPLICANT O OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: [ContactName] CONTACT PHONE: [ContactPhone] Susi urrui-ia.of'1 @ mall, corit <br /> S (1- -y CONTACT EMAIL: [ContactEmail] L/ 5 — 75Q —goy 3 <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 /> pe orm the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> PI h I,�A„ flYn /Ile <br /> f City of Everett Official Use Only <br /> { J �`Ol�� 1 PERMIT# <br /> PW1610-007 <br /> ` <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br />