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PUBLIC WORKS PER' IT APPLICATION <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@everetfwa.gov l www.everettwa.gov/permits <br /> - - PROJECT`SITE INFORMATION` <br /> PROJECT ADDRESS: 2_� Lr M SOV C.� :.;. <br /> IF APPLICABLE: ❑LAND USE PROJECT#(SEPA,PRE-APP,SS,ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED DSFR ATTACHED CIDUPLEX CIMULTI-FAMILY OMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF-USE? ,tet NO ❑YES, FROM TO <br /> • <br /> NEW WATER/SEWER SERVICE NEEDED? ,).d110 0 YES,TYPE • SIZE <br /> SITE WORK/RICHT-OF WAIS APPLICATION iiveiiiiiviAtiok <br /> DESCRIPTION OF WORK: .. <br /> (�,r & f \ L -3L lem_po <br /> iNc- -0-- kb Cu-P1-43 ki-Adure-N 04 tprobk- q •retA41/4.4st. 7TtflA_ <br /> rt-Voom-if tyre- CA&J • -Iv eAI U\ 19,A0V rP}> <br /> ❑FENCE IN ROW FT IN HEIGHT <br /> ❑DRIVEWAY APRON/CURB CUT / • <br /> FT WIDE <br /> ii(ASPHALT CONCRETE PAVING 1260 SF <br /> 0 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 /> 0 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACTINFORMATION . <br /> .P� <br /> OWNER NAME: .t�,' �• IA� 1\4-A -0 T c ` ��Y(( L t . . <br /> OWNER MAILING ADDRESS: sTREEr ,` i 6\ \ 6 - 1 v L <br /> CllY e_.0 R. ►\... — ATE .2_ <br /> OWNER PHONE: ctz 5 - 2 18, OWNER EMAIL: .. v. IN&Q. I3 I's•Pi•-e 1t+1A•t t• COm <br /> APPLICANT NAME: <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE zip <br /> APPLICANT PHONE: •APPLICANT EMAIL: <br /> PRIMARY CONTACT: NER ❑APPLICANT I:1OTHER(Architect,Engineer,Etc.) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> ACKNOWLEDGEMENT*!have reviewed this application and confirm the Information contained herein Is true and coned Work drone pursuant to flits permit must <br /> comply with current federal,state,end local law.The granting of 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 Elie owner,or!am authorized by the owner of this property to <br /> perform the work for which application is made,and .mply with the State Contractors Law 18.27 RCW and 296.200A WAC <br /> City of Everett Official Use Only <br /> PERMIT# <br /> A k <br /> f 2--)P I tK Pel 1802—62g <br /> fluannrfAntRnrivoA Antall.Ctnnofnro rlata Mavfcarf 1R/19/9119A1 <br />