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PUL IG WORKS PERMITLOG TI N <br /> #.11111P"/"r%;-‘*- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION; <br /> PROJECT ADDRESS: /6 Cfd'24,-- e ( e f/ °f X67 qr?l l <br /> IF APPLICABLE: O LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:OSFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL CI INDUSTRIAL <br /> CHANGE OF USE? ONO O YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE <br /> SITE WORK I RIGHT OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: <br /> *FENCE IN ROW FT IN HEIGHT <br /> O DRIVEWAY APRON/CURB CUT FT WIDE <br /> ❑ASPHALT/CONCRETE PAVING SF 1 <br /> 0 RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> AH 09 2018 <br /> 0 RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> 0 CLEARING/GRADING/FILL/EXCAVATE CY CITY OF EVERFT I <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF 9 Permit ,SAI ii,i <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: SP ' C/5 (Z2.9720,5 re,ri-e <br /> OWNER MAILING ADDRESS: STREET G--I4-I S 5 T . 'r 2 <br /> CITY 8 U -4 f,r Jr( STATE te.A ZIP grz 3 7 <br /> OWNER PHONE Go) 'L©`_ (/ OWNER EMAIL: <br /> APPLICANT NAME: ��)5 V6 '& C",f�l <br /> 0S [9p • LI lilt* 113A-14/1-1 <br /> APPLICANT MAILING ADDRESS: STREET /-3-/ T�?�2_c 7 A <br /> CITY F(/`C// of STATE Wj�: .2 l ZIP � �ZoI <br /> APPLICANT PHONE I `OG)Z 50 257 0 APPLICANT EMAIL: <br /> if) <br /> PRIMARY CONTACT: 0 OWNER APPLICANT O OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: , CONTACT PHONE: 02,00 25a i$ <br /> Ve15 `� V a j2' i $ 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 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 /> fr),-f-14 Por,c-97. 04t/aq/z r PW /c*R.PL <br /> Owner/Authorized Agent Signa re Date (Revised 10/12/2015) <br />