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PL ... LIC WORKS PERMIT LICATION <br /> 4 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 SITE INFORMATION <br /> PROJECT ADDRESS: '7/7 Sf SE >=✓e/e2Y W 4 7152,03 <br /> IF APPLICABLE: D LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:1ESFR-DETACHED -PSF-R ATTACHED 4g-BtePLEX itT!-FAMILY ❑COIV1MERCIAL $ttNInUSTRIAL <br /> CHANGE OF USE? 7 NO ❑YES, FROM TO <br /> NEW WATER I SEWER SERVICE NEEDED? 7 NO 0 YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: Co,/1S7 v�� 0✓1 aT/ Iiu ' S/n1/t' 7-arY)/�y I io#vi Y 6/a ►'ep(4 ct) <br /> -(e/S717 el, ge//g4 ;--A) <br /> Ifi FENCE IN ROW o'2 pri7 7 /' lj FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> ®ASPHALT/CONCRETE PAVING /t' 8 SF <br /> 0 RETAINING WALL/ROCKERY IN RIGHT-OF-WAY — LF <br /> 0 RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT — FT TOTAL HEIGHT <br /> ME CLEARING/GRADING/FILL/EXCAVATE Ltd CY <br /> 0 CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: / 4b(fif1 'fp� 14-0,01"26/427 O� 54Vl4row fSG! GO. <br /> OWNER MAILING ADDRESS: STREET /I 1 b I tt ukt I9 gh IDD <br /> CITY Lfpin nod 1" STATE WA' ZIP 1' ? <br /> OWNER PHONE: (( OWNER EMAIL: <br /> APPLICANT NAME: Shot/M. 45 OGU/Jrf <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: $OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, <br /> fiEnggineer, Ettc.) <br /> CONTA TNAME: CONTACT PHONE: C42 <br /> '7Zz - —4064 <br /> GpSkNL� �11 <br /> CONTACT EMAIL: cm, CO krh sc 'C5vi? <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursdant 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 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> PW ( -70 - 0W <br /> Owne -orized Agent Si Date (Revised 10/12/2015) <br />