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PLIC WORKS PERMIT _PLICATION <br /> '417. 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 /> 7 11 ' ' PROJECT SITE INFORMATION <br /> ._ . . ,..�_ .. .. -- _._..,. . ��� � ,, :. ,_ .�, .� � Wim. =,.M.N_ ,___ . �-----_..� ._ _a._.._..- - -.... <br /> PROJECT ADDRESS: r o 3 1 5 ME/2i1,) lb N i Je- . S ,EUe.12E!rl w A- q(2O4 <br /> —IF ARP' E: El LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: SFR-DETACHED I:SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY DCOMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? X10 0 YES, FROM TO - <br /> NEW WATER/SEWER SERVICE NEEDED? 'INO El YES,TYPE - SIZE <br /> i ' " .... . 1:010 OR tikl. HTi:OFi;WAY APPLIeWrI II NFORA,T ONS . . w <br /> DESCRIPTION OF WORK: A7 / /h del CA f h 40/-?7L 074' house <br /> app i^ox 38 (l. ins71t a Jz '` p00,e. <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 /> 0 CLEARING/GRADING/FILL/EXCAVATE CY <br /> El CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> - OWNER NAME: MA 1 'TW-{-A I\11-1 — TUN G f R 1 5✓` , <br /> V' <br /> OWNER MAILING ADDRESS: STREET 44 C /2-yam/el <br /> 11'S V q <br /> CITY ,e STATE A- ZIP l S?4,1,Oce <br /> OWNER PHONE: 42 5,:- 2,24 7., 015-C OWNER EMAIL: zC?.....7/--l . .., ..,.5_.!„.„, ..,_.w,_ <br /> APPLICANT NAME: S4 n--e. <br /> APPLICANT MAILING ADDRESS: STREET <br /> CIN STATE ZIP <br /> APPLICANT PHONE: R � APPLICANT EMAIL -- a_a.- -- ._. ..-- ,a �< <br /> PRIMARY CONTACT:OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: (7 >J 4 ) CONTACT PHONE: Oa/nth <br /> 771-A N11 ,TU iv a. M 4--I CONTACT EMAIL: gAm.e <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 application is made,and I comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 4 / PW / 701 -057 <br /> G,.4Lit.�// i.��� /i 7 <br /> Owner/Authorized Agent Signature/ spr Date (Revised 10/12/2015) <br />