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PUBLIC WORKS.PERMIT AgLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT ADDRESS: Zy <br />IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) <br />SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI -FAMILY ❑COMMERCIAL NDUSTRIAL <br />CHANGE OF USE? U NO ❑ YES, FROM TO <br />NEW WATER / SEWER SERVICE NEEDED? Ef NO ❑ YES, TYPE SIZE <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein i"ue aand `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. 1 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 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />PW/7UR-03$ <br />(Revised 912312016) <br />