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PUtLIC WORKS IT APPLICATION 11.111P.I*►' y CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: , W D 8 10 S r STREET 5 E IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE APP,SS, ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY El COMMERCIAL 0 INDUSTRIAL CHANGE OF USE? 0.NO ❑YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? Dii$1O 0 YES,TYPE SIZE SITE WORK I RIGHT-OF-WAY,APPLICATION INFORMATION DESCRIPTION OF WORK: a R ET AT I,vG 1n,A L 4S o r Sz ES' 0 j P io P E R T y 7-0 F-ac.ILITATE l- EELrn%a OF Be4cK YARD ❑ FENCE IN ROW FT IN HEIGHT FT WIDE I'\\f!r117-17-:A 1.1 El DRIVEWAY APRON/CURB CUT E q L:=3II 0 ASPHALT/CONCRETE PAVING SF 0 RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF mtv 2 2 2017 o RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEl kali a ❑ CLEARING/GRADING/FILL/EXCAVATE CYPerttyV;.s;q•.9 ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF CI TY OF EVEETT ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION. OWNER NAME: /14/1 I'11 /V E W L A A,0 sT OWNER MAILING ADDRESS: STREET GIL108 101 STREET SE CITY E✓ERFTT STATE >"4 ZIP 9 8.1 0 S OWNER PHONE: a06 - aid - 87.c OWNER EMAIL: ILIDUSE- REMoDFL e 'Sc,gDrq wCASEL , corn APPLICANT NAME: /vl A R) /V £ l„, L A^'0 APPLICANT MAILING ADDRESS: STREET oZ L(0 g to I 'LI SIRE E.i- SE CITY 1=v£g E T T STATE t1/' A- ZIP cf'a APPLICANT PHONE: ad- c�a '- 875a, APPLICANT EMAIL: NousE REMobEL cAscflnsA wEASaL . coM PRIMARY CONTACT: AOWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must 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 authorized in writing from the Building Official before being authorized under any circumstance.I am the owner,or l am authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# � f 4,515 PW I Owner/Authorized Agent Signature Date (Revised 10/12/2015)