Laserfiche WebLink
SLI B� ® :S PEs IT t =, LICATN®11.1/4411-/—P°. �! <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION`. ._ <br /> PROJECT ADDRESS: 4 OO 7 t tk- / / ,¢,/ <br /> IF APPLICABLE: 0 LAND USE PROJECT#(S 'A,PRE APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? ❑NO ❑YES, FROM TO - <br /> NEW WATER!SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: 0} /1,N7)7LE f tt&iC— lb Ice- `'' dicey' <br /> tAy- lipoyyvf <br /> 0 FENCE IN ROW FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> ASPHALT/CONCRETE PAVING U) 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 /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> f <br /> OWNER NAME: (JL 7ft 7f- oS't ffi <br /> OWNER MAILING ADDRESS: STREET ®O - £©G,C e,- e ((di C <br /> CITY -{J Cf✓e STATE / ZIP 3 <br /> OWNER PHONE: 20 6 ..-_471.1 2,`L 6 c OWNER EMAIL: .5 <br /> Sup jet <br /> W <br /> APPLICANT NAME: <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: AWNERHYw❑APPLICANT 0 OTHER(Architect, Engineer, Etc.) <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 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 /> 2_ / pw <br /> Owner/Authorize Agent Signature Date (Revised 10/12/2015) <br />