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Pt-L1WORKS PERMIT - • LICATION <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.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: b / 111 -tl <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED El DUPLEX ❑MULTI-FAM ILY ❑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: <br /> FENCE IN ROW FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> ❑ASPHALT/CONCRETE PAVING SF C <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF r a I{} VR <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGH rt <br /> APR 2 t 2018 <br /> CI CLEARING/GRADING/FILL/EXCAVATE CY <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF C i #, OF EVERETT <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Permit <br /> CONTACT INFORMATION <br /> OWNER NAME: Cas+ <br /> OWNER MAILING ADDRESS: STREET a- 5-0 C I/Lt <br /> CITY �,�// �/ <br /> STATE !�- ZIP <br /> OWNER PHONE: Z — -3 "3 40::Fc".3 OWNER EMAIL: <br /> APPLICANT NAME: <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: 0 OWNER 0 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.lam the owner,or lam authorized by the owner of this property to <br /> perform the work for which application is made,and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> rZo l - <br /> (L,,,,a_S-de2 oy <br /> .� <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />