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=LC WORKS PLICATION <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 INR <br /> FOMATION' <br /> PROJECT ADDRESS: 3413 6 Lo" "n-( <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS,ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY CI COMMERCIAL 0 INDUSTRIAL <br /> CHANGE OF USE? 0 NO 0 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: WIIj(j) U\ p2(141/)-t-y-e s t g2`,....k <br /> �23.173N ,5 War\ ( _ a L l <br /> ❑ FENCE IN ROW FT IN HEIGHT <br /> ❑DRIVEWAY APRON/CURB CUT FT WIDE <br /> ❑ASPHALT/CONCRETE PAVING SF <br /> ❑ 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 /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION _ <br /> OWNER NAME: <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: _.. ..w . v. M, �x. _ .. <br /> APPLICANT NAME: e � V1 Birt yx^ �el,"r 4270 <br /> APPLICANT MAILING ADDRESS: sTREET o71 el. 'V C Ce9mp P2 37 <br /> c (e...._�� � ZIP � 1uD <br /> Q CITY \� I STATE `I <br /> V APPLICANT PHONE: 11 IIIJJJ APPLICANT EMAIL: eniC BUSINESS ut o via <br /> .,,T.�m..,�...�..w.�.��..�,...n ,n.r�. . ....,�,.�m.. .g ..�.� ..�„a,.,,.,.. ,...�m.r .�.��.� .. w_,�... ,.�...... .,.�....n..�,.n, <br /> PRIMARY CONTACT: 0 OWNER 14,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 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 /> 0(4.4i.A. <br /> PWW IQ6-OO <br /> 1 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />