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Ojen. PALC WORKS PERMIT Pm=4LIcArIoN <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 ADDRESS: . 3 9 3 S boa/ lVE 1� t/t/ <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, dSS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX El MULTI-FAMILY EYCOMMERCIAL DINDUSTRIAL <br /> CHANGE OF USE? ❑NO ❑YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE <br /> lagirriKTYMORC, W91W4A.670"4:=:440: 0107 ION INFQR nr° p { . , F_v# 4e <br /> DESCRIPTION OF WORK: ) e d - * wvv-`- et,U 4- deh/I jts` _ <br /> -�' ►�,�,� =tip Y , 1 I ' r/(.e.e cd , vlbfri1/45 <br /> we to <br /> d /4- a- 14wP-flefe-e- Ca)/Le d <br /> ❑ FENCE IN ROW FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> 0 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 /> 0 CLEARING/GRADING I FILL/EXCAVATE CY <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: 'C(�-e✓��{'� ( /O'Wl e9-e_ <br /> OWNER MAILING ADDRESS: STREET <br /> / 0 1 rb ,Q e.'i^ <br /> G.1/'r/ $ <br /> CITY YC/" STATE /VA- h)2G ZIP n <br /> OWNER PHONE: ��j `�j e r q a 3 OWNER EMAIL: et�i✓1 e 'eo ,'I/�T a e ` e UI <br /> APPLICANT NAME: ra'1Th}i'j CiLK-- cJ1/I4:9 ClavN, <br /> APPLICANT MAILING ADDRESS: STREET 200 6 t4 v' S ti ,r� <br /> CITY v V�'i- <br /> - Csi+ STATE /A)4- ZIP q Z5 <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT:Y`L❑ OWNER rAPPLICANT ❑OTHER(Architect, Engineer, Etc.)-. <br /> CONTACT NAME: ,�p,,^ CONTACT PHONE: 42r?. 1€g, ( q $ 3 1� _/ <br /> G '�C 6i01 r9�'-' CONTACT EMAIL: p 140 k9 c evt e Cj�f2/+Q`67`C C , e C.I . <br /> ACKNOWLEDGEMENT:1 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 l 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 /> d7F-- p • <br /> // t7/ / PW /8f1 0 42 <br /> 0 ner/Authorized Agent Signature Date (Revised 10/12/2015) <br />