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PUBLIC WORKS PERMIT APPLICATION <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 https://everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2?01 le AVE <br /> SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED El DUPLEX ❑MULTI-FAMILY ReOMMERCIAL DINDUSTRIAL <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> IF APPLICABLE: 0 FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# <br /> UTILITY COMPANY'S NAME&JOB#: JOB# <br /> DESCRIPTION OF SITE WORK/ RIGHT-OF-WAY WORK <br /> FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: <br /> ❑FENCE IN ROW FT IN HEIGHT <br /> ❑DRIVEWAY APRON/CURB CUT FT WIDE <br /> ❑ASPHALT/CONCRETE PAVING SF <br /> D rE II V E, <br /> ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEI OCT 16 2018 <br /> o CLEARING I GRADING/FILL!EXCAVATE CY �✓ <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF CITY Permit OF E V E RT <br /> Ers <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> ❑ POLE WORK/AERIAL/OVERLASH LF <br /> ADDITIONAL DESCRIPTION(AS NEEDED): <br /> 4 -r2cF.s ALook& u i -r-i- Fwd CcsLY wv�, <br /> CONTACT INFORMATION <br /> OWNER/APPLICANT NAME: S kp}-d12 pcI l sf a.. L_ A-t-16 ta, Mei i tie- <br /> /� <br /> OWNER/APP. MAILING ADDRESS: STREET 2:4-63- Col ivy �et1u� , S LLV4-e-(2OC7 <br /> CITY IFv ri / STATE �►A- ZIP 416201 <br /> OWNER/APP. PHONE: 425. Z52• 5 o OWNERIAPP.EMAIL: Orgela. nercu.J!e•E sk..ofdal.Co <br /> CONTRACTOR NAME: 'Davey he,_ E-2,p .r¢- Co - p�'Y <br /> CONTRACTOR ADDRESS: l7 STREET v,0. BrJ i( ZH' c ) <br /> CITY <br /> 1.e_ STATEW ' ZIP 4'004 <br /> CONTRACTOR PHONE: 20(p 82 q . 85� CONTRACTOR EMAIL: j QS try, ,/1121 ze-Q Cia-y-ey. CO/VI <br /> CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#('REQUIRED): <br /> PRIMARY CONTACT: 2'OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: 4z•2 •54oO 4-Z_1c 309•131 3 <br /> /trig ��egr-cuij F CONTACT EMAIL: ary e(Q,,/her-64Z CT e Sfc�al. co m <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 lam 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 /> capg „ <br /> PW / e> 0-- ��3 <br /> Owner/Authorized .=nt Signature Date (Revised 1/52017) f <br /> ( 11_ <br /> 7' <br />