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/7e).546-078 <br /> PUDIC WORKS PERMIT ALICATION <br /> �►/ -- - CITY OF EVERETT PERMIT SERVICES <br /> i� 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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: /03— ht s T 6,9.5/NO 4'oM9 Et/E/QE?7 Gq A • / 0'09 <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAM ILY gbOMMERCIAL El INDUSTRIAL <br /> CHANGE OF USE? NO ❑YES, FROM TO - <br /> NEW WATER/SEWER SERVICE NEEDED? d�NO 0 YES,TYPE SIZE <br /> SITE WORK/ RIGHT OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: %4' OUT ,qs&j it //1AtoANT o, Age' tett/6;9e /'/9/4K/4/�/ <br /> is AND 1PIT NEx LONc4ETe Alta to /690 �,.74e A a6X 6s� <br /> AND /fce5 rR/fie ,QV/A1 /44e Appv4/4 y40yc, /9/9AKi, (3�i) <br /> ❑ FENCE IN ROW FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> ASPHALT/CONCRETE PAVING /‘96 SF <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> O 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: 5M9/QcT/9/1 E/1��F/P�/'P/sG�s� #GC C• <br /> OWNER MAILING ADDRESS: STREET 38'31^ TBSP ,6 51. <br /> YisfAiH/000 CITY STATE /, ZIP f t 3 7 <br /> OWNER PHONE: ilo25 R/4?-1040201 OWNER EMAIL kers»/t' 4404 ,1)4.1/COr60114 <br /> APPLICANT NAME: /9/6 P'IT tiOlge <br /> APPLICANT MAILING ADDRESS: STREET 303 — I .5-4 /j. S <br /> SG . A <br /> CITY /YNN �''`/D STATE /Vg • /ZIP 0�37 <br /> APPLICANT PHONE g •?47 ..... '�. APPLICANT EMAIL: �Cer/Mf et4t/0l7 @4 0.74L/ C'd-71-7y <br /> PRIMARY CONTACT: 0 OWNER idAPPLICANT 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME:ire—A94, , /xee / CONTACT PHONE: 10157:- '/,- 'VOA <br /> CONTACT EMAIL: /re,,,ka46/I( mai/. CO/y? <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct fork 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 1 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 /> %��li/ S 3m /7 PW 1705— D5 I <br /> Owner/Autho ed Agent Signature ■ate (Revised 10/12/2015) <br />