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PLIC VY •I I! S -E.• l',/)IT i A L1CAT ON <br /> 4111117/— <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.govlpermits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: <br /> 42o , ✓e-en U) Jtr e)17-1-- k..00-- �'C2 03 <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPI(,PRE APP,SS, ET .) <br /> SITE WORK FOR PROJECT TY E:CISFR-DETACHED ❑SFR-ATTACHED ['DUPLEX ❑MULTI-FAM ILY YJ COMMERCIAL ['INDUSTRIAL <br /> CHANGE OF USE? NO 0 YES, FROM ,- TO - <br /> NEW WATER!SEWER SERVICE NEEDED? NO 0 YES,TYPE SIZE <br /> , <br /> SITE WORK/RIGHT-OF WAY APPLICATION INFORMATION <br /> yy / / <br /> DESCRIPTION OF WORK: 3'7Loc./G ,i 4 ,Jo// 0✓I (Or �� Zi- - a7 4a- <br /> t4e- P4,1-41 <br /> ❑ FENCE IN ROW FT IN HEIGHT it' <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE t v <br /> ❑ASPHALT/CONCRETE PAVING SF — t . , 9 'r <br /> ❑ RETAINING WALL!ROCKERY IN RIGHT-OF-WAY LF i E(". n=f ,/ rF£ I ; 1 <br /> ❑ RETAINING WALL!ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGH r" <br /> ,/ D .0 - 5 2017 ! <br /> IN CLEARING/GRADING/FILL/EXCAVATE 0 CY <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF CITY OF EVERETT <br /> Permit Services <br /> o CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> OWNER;., <br /> CONTACT INFORMATION . <br /> R NAME: Ar24' -... \./' s> / it/lit 71;r/CD vi <br /> OWNER MAILING ADDRESS: STREET ZI(,Z Q Eve zed r e-J ,A/ <br /> .1re._0 CITY `A 1A-- 6i P,Z-In STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> APPLICANT NAME:-......:1 Vie JAAmc <br /> APPLICANT MAILING ADDRESS: STREET 2S -�, W U&ti IA e0 ..ceeee t 7 C_ <br /> t/V- t IC,I i fil CITY I 'f V cATE f}-. ZIP �2 7 <br /> APPLICANT PHONE 42S-- (D Z APPLICANT EMAIL•. Cr()v1 <br /> tAVIL_ �Cr() Ue ffe dlt,,nu r 25 <br /> PRIMARY CONTACT: 0 OWNER VAPPLICANT 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: 4 2 c 24b- 2,gt t <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 loc.-I-law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be <br /> authorized in writing from the Buildin• 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 applic..ion 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 /> C. ''-- - ___ pw i112—c <br /> 0 erlAuthorized ent Signature Date (Revised 10/12/2015) <br />