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P UUC ;i * 'PKS PEi ', IT UUC TI N � Of 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: 2310 (,)'1-h Stre&...` IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 0 NO 0 YES, FROM TO - NEW WATER/SEWER SERVICE NEEDED? yi NO 0 YES,TYPE SIZE -SITE WORK I RIGHT-OF-WAY APPLICATION INFOR• MATION DESCRIPTION OF WORK: revtne 91 V I veAivQ / ❑ FENCE IN ROW FT IN HEIGHT DRIVEWAY APRON I CURB CUT FT WIDE ❑ASPHALT/CONCRETE PAVING SF ❑ RETAINING WALL/ROCK ERY IN RIGHT-OF-WAY LF ,# ., ""g j s ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEI it IAN — C 20.4 ' I 18 Li o CLEARING/GRADING/FILL/EXCAVATE CY ;,yp or: A._ ❑CUT/BORE IN PAVEMENT(PARALLEL) LF .-; L..V1.171-ct 1 I Perrnit Se,ry i--,.„ o CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION OWNER NAME: —be —17)11-1 MI CYI t=LN S OWNER MAILING ADDRESS: STREET/)(0 [7Th S--i-r CITY ever ..--.1- STATE WA- ZIP—` 2O t OWNER PHONE: 422-2(114- S OWNER EMAIL: 1,1-F I q G'cc, MGtI , COM ,,__.�.. APPLICANT NAME: ( k)e M1 1 ckecti,� APPLICANT MAILING ADDRESS: STREET I-- 2'.". („ 4,, J - Tee l1 �/ CITY ve eiL` STATE VQ4 ZIP -! ( 1 APPLICANT PHONE: 4_26_2101_ APPLICANT EMAIL: p t-ri q ,k) • corn PRIMARY CONTACT: 0 OWNER 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 I 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# ''�•11ICi,, �_� , � � c( / 60/- 02-1 Owne • thorized Agent Signature Date (Revised 10/12/2015)