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4, FBLIC WORKS PERMITPLICATION <br /> CITY OF EVERETT PERMIT RVICES <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: 1127 GRAND AVE <br /> IF APPLICABLE: O LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: OSFR-DETACHED OSFR-ATTACHED =DUPLEX O MULTI-FAMILY O COMMERCIAL <br /> CHANGE OF USE? = NO = YES, FROM TO • <br /> NEW WATER/SEWER SERVICE NEEDED? O NO O YES,TYPE SIZE <br /> SITE WORK/MIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: NEW DETACHED GARAGE <br /> O FENCE IN ROW FT IN HEIGHT <br /> O DRIVEWAY APRON/CURB CUT FT WIDE <br /> =ASPHALT/CONCRETE PAVING SF <br /> O 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 /> O CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> O CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: ACCETTURO MARIO&MELINDA <br /> OWNER MAILING ADDRESS: STREET 1127 GRAND AVE <br /> cny EVERETT STATE WA ZIP 98201-1508 <br /> OWNER PHONE:4254222033 (OWNER EMAIL: MSTER1313@HOTMAIL.COM <br /> APPLICANT NAME: [AppNamel <br /> APPLICANT MAILING ADDRESS: STREET [AppAdd] <br /> CII [AppCi] STATE [AppSt] ZIP [AppZip] <br /> APPLICANT PHONE: [AppPhone] (APPLICANT EMAIL: [AppEmail] <br /> PRIMARY CONTACT: O OWNER O APPLICANT = OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: [ContactName] CONTACT PHONE: [ContactPhone] <br /> CONTACT EMAIL: [ContactEmail] <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. I am the owner,or I am authorized by the owner of this property to <br /> perform the work for which a2lication is madg,andcomply with the State Contractors Law 18.27 RCW and 296.200A WAC. ' <br /> (/ 77 City of Everett Official Use Only <br /> I PERMIT# <br /> PW1607-052 <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br />