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4rerr PlipLIC WORKS PERMIT P PLICATION
<br /> CITY OF EVERETT PERMITS ICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov www.everettwa.gov/permits
<br /> R0 _� T1 O A f
<br /> P J CT SITE NF. RM TION
<br /> `= __..._•. _. .`'-- _ _�. ..._ v ,., _...r:�.� ^ .,.c�n.. . ....,,,,, ....�,.._ ,. ...,
<br /> PROJECT ADDRESS: 6,40 Q tu wk.(
<br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE APP,SS, ETC.)
<br /> SITE WORK FOR PROJECT TYPE:El SFR-DETACHED ❑SFR-ATTACHED ID DUPLEX ❑MULTI-FAMILY ,COMMERCIAL ❑INDUSTRIAL
<br /> CHANGE OF USE? SNO 0 YES, FROM TO
<br /> NEW WATER/SEWER SERVICE NEEDED? iKNO 0 YES,TYPE SIZE
<br /> •
<br /> SITE WORKJRI4GHT OF WAY APPLICATIONINRORMATION
<br /> DESCRIPTION OF WORK: t H OVA )cE AL--T ,<L�1,-)i6 evet-ot.esu
<br /> TzDUtA G
<br /> ❑ FENCE 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 /> ❑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: SPEC(ACL k TEMST O?- 0t01/4( / . AY 6 ft QM+L
<br /> OWNER MAILING ADDRESS: STREET j 41- ( 0 EUS ..02,E kJ-Ay
<br /> CITY
<br /> k) I J T STATE WA ZIP CICS:. 0 2,,p 1
<br /> OWNER PHONE: 9--2-9 ;;8 1"35;^ 2- OWNER EMAIL: Sift,Q(i3O. q,- e.-
<br /> APPLICANT NAME: C. }k l)IDE(.-SO 1.) Ac' IT --C S 6,44aH bLLe2.
<br /> APPLICANT MAILING ADDRESS: STREET 72.Q°l C"ra.E6ii( OOD A U
<br /> CITY )ct vj I✓e- STATE W ZIP `181 O`,
<br /> APPLICANT PHONE: c 182-"2.5111 APPLICANT EMAIL Q b L 0._C-(00‘.— ct. tdik• COM_
<br /> .- ,.,,..n.m,�..�m..._,,..�..P��c.....,.,�,., .:,.��.,.�.,'...v�,.�.-�x,.
<br /> PRIMARY CONTACT: 0 OWNER .APPLICANT 0 OTHER(Architect, Engineer, Etc.)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> ACKNOWLEDGEMENT'1 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 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 /> /1PW602_04
<br /> 2/3/Z 1
<br /> 0 .ner/Authorized Agent Signature Date (Revised 10/12/2015)
<br /> GZ
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