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AfilP •UBUC WORKS PERMLT7APPLICATION <br /> CITY OF EVERETT PERO I SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> : PROJECTSIT.EINRMA'i'ION x ...__... ._. ,.__.., - .. .... <br /> PROJECT ADDRESS: CI®q P% yD i�, 57 c.e—`fir, Z fi / <br /> IF APPLICABLE: 9 LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: SFR-DETACHED ❑SFR-ATTACHED DDUPLEX DMULTI-FAMILY D'COMMERCIAL ID INDUSTRIAL <br /> CHANGE OF USE? &O 0 YES, FROM TO - <br /> NEW WATER 1 SEWER SERVICE NEEDED? RENO D YES,TYPE SIZE <br /> �` �� =:SITE WORK%�RICHT�OF-WAY'~APPLIC�AT10Ns1NFORMA�TtON � ' � a <br /> l� n. rx8�+: a..:rsse�ao-san' <br /> DESCRIPTION OF WORK: r,i►,6Jt-Gt /� L't 'v�' ( 2c I ' "� 1�i cj t I ®' c-tia .- <br /> Ertnc-c- <br /> D FENCE IN ROW FT IN HEIGHT <br /> D DRIVEWAY APRON/CURB CUT FT WIDE [ECIENEASPHALT/CONCRETE PAVING SF <br /> D RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF JUN 2 8 2017 <br /> 9 RETAINING WALL I ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT — <br /> D CLEARING/GRADING/FILL/EXCAVATE CY CITY OF EVERETT <br /> Permit Services <br /> 9 CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: C.ov' C) k '►"hop'^' <br /> OWNER MAILING ADDRESS: STREET T°9'. P;rt �T re e1 <br /> CIN c.-Ate/HT1 STATE (A)a, ZIP q�GY/ <br /> OWNER PHONE 2 5.3 1°6> Sag OWNER EMAIL eirA^ Ol'Ia�T *r1 (/LvT�'f'�t�� • LC�t'+! M � <br /> APPLICANT NAME: 14 s �f <br /> APPLICANT MAILING ADDRESS: sTREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: !APPLICANT EMAIL: .�- <br /> PRIMARY CONTACT: .DOWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: 40, <br /> ®YET(rat CONTACT EMAIL: r j c iNtd� <br /> ACKNOWLEQCEMENT.l have reviewed this application and confirm the information containe erein isf true and correct. Woe 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 I 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 /> pw cloy--coR <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />