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f,, PUBLIC WORKS PERMIT A 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 INFORMATION <br /> PROJECT ADDRESS: 59 c o 3(0-t'r+l Ave L).3. i SveRer ,', ( A 9$20 <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS,ETC.) N+9 <br /> SITE WORK FOR PROJECT TYPE:DSFR-DETACHED C ISFR-A1 TACHED ODUPLEX OMULTI-FAMILY $COMMERCIAL CIINDUSTRIAL <br /> CHANGE OF USE? VINO ❑YES, FROM TO <br /> NEW WATER I SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE Abgl SIZE <br /> SITE WORK I RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: Vboc R 1iRucAC 011ExisnitAci t..T ^ 4 %ht <br /> (c,JoRk m 71 kE ' A AT29r .'t"1a_IIr- od SOCAt.JO AVE.} <br /> O FENCE IN ROW FT IN HEIGHT <br /> O DRIVEWAY APRON/CURB CUT FT WIDE <br /> O ASPHALT/CONCRETE PAVING SF <br /> 0 RETAINING WALL I ROCKERY IN RIGHT-OF-WAY LF <br /> 0 RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> ❑CLEARING/GRADING/FILL I EXCAVATE CY <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> 0 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: Ledi 38 L.4G• <br /> OWNER MAILING ADDRESS: siissr I04o W.6gtecut4Iw gs.)SuaBoo <br /> cm, V0ltrtaU•v'ER.. s a $G (.CAAPitspv4) LP <br /> OWNER PHONE: 'OWNER EMAIL: <br /> APPLICANT NAME: 140S EROS COWStftuc.rtbt.L it4G. <br /> APPLICANT MAILING ADDRESS: STREET(Pt2.e4X 1189> -1-153 Vw. e,STi AM <br /> ROW � <br /> ►t �y <br /> CRY woaoi"lt4V1 E STATE t )� ZIP '6C 12. <br /> APPLICANT PHONE: IAPPUCANT EMAIL: <br /> PRIMARY CONTACT: 0 OWNER APPLICANT 0 OTHER(Architect,Engineer,Etc.) <br /> CONTACT NAME: ,t. CAfL12.. CONTACT PHONE: Ct12,g,,) 2 ..3E4 <br /> CONTACT EMAIL: } oskre,s,GG^r\ <br /> ACKNOWLEDGEMENT::I have reviewed this application and confirm the Information contained herein Is true and correct Work done pursuant to this pennit 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 I am authorized by the owner of this property to <br /> perform the work for which application Is made,and l comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 41119011 PW Id1_®lg <br /> Owner/Authorized Agent Signature Date (Revised 9i2312016) <br />