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PLAIOLIC WORKS PERMITLICATION <br /> "111°'..14://---.4„iiiig -_ 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 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION, <br /> PROJECT ADDRESS: 05 I J �pie._, Sir- -' <br /> . i ` /v •� / l�7TC <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX El MULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL <br /> CHANGE OF USE? ❑NO ❑YES, FROM TO . <br /> NEW WATER/SEWER SERVICE NEEDED? 0 NO ❑YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: 'efCt� s/nc\ 41 x _ f ?Oak CUP)4 <br /> "1,0 i o u.o.,-\, , 4 1 r o r) ° ?ce---RDAD ”'N.) ---6 icy 9-9 ar)0_,.. 1 h (RO IA) <br /> Li <br /> kCF �a ENCE 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 /> 0 RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> 0 CLEARING/GRADING/FILL/EXCAVATE CY <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> 0 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: L I V/}'1 l ruSf <br /> OWNER MAILING ADDRESS STREET zgq�4 nri Av 42----- <br /> lel '^ STATE ZIP / ! ��CITY /c1 Com` <br /> OWNER PHONE 50 6,/qO�'/ OWNER EMAIL d k o,_11:1- C,11,4,--6.Y 11e <br /> k. <br /> APPLICANT NAME: L'eA n..hC ! <br /> Q� ..L <br /> v-of <br /> APPLICANT MAILING ADDRESS: STREET ) I T `cQ-� . <br /> �g) <br /> CIN "rt/Zy^ <br /> STATEt0 a ZIP?$ <br /> o <br /> APPLICANT PHO E: Q d APPLICANT EMAIL: Le Qnn r at_m_ m DI <br /> PRIMARY CONTACT: 0 OWNER APPLICANT 0 OTHER(Architect, Engineer, Etc.) .1 ,. <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <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 lam authorized by the owner of this property to <br /> perform the work for which appli - on is m-•: -nd I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> OKI <br /> !.� /6 ;'PW /608 C42. <br /> Owner/Authorized Agent•'gnat ap Date (Revised 10/12/2015) <br />