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<br /> PUBLIC WORKS PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> P 425-257-8810 FAX 425-257-8857 E everette s everettwa. ov www.everettwa. ov/ ermits
<br /> ( ) I I ( ) PCB 9 � 9 P
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<br /> PROJECT ADDRESS: s U (���t` I �V �If— '' �l_r I rl V lk-fA� . 0()E.Mare Vlaw D h-
<br /> IF APPLICABLE: ❑LAND USE PROJECT#(SEPA,PRE APP,SS,ETC.)
<br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL —INDUSTRIAL
<br /> CHANGE OF USE? -fitbNO ❑YES, FROM TO
<br /> NEW WATER/SEWER SERVICE NEEDED? .4NO ❑YES,TYPE SIZE
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<br /> DESCRIPTION OF WORK: (nS-?11 nn�' cf TU kt,I I e wk(C- PI Pe rile_ , _
<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 I`i
<br /> //1----
<br /> ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT
<br /> ❑CLEARING/GRADING/FILL/EXCAVATE CY .
<br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF
<br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF
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<br /> OWNER NAME:TV I a.l i p Tr i\oeS
<br /> OWNER MAILING ADDRESS: STREET (1)1-4 0(40 CrCIn n� r)rV-C..
<br /> ar' 'TI 4 O\I p STATE L zip i cT l!
<br /> OWNER PHONE: �j( O —7 I Lo 5O2 4 1DWNER EMAIL: CI b.ra,L1 @'{-o I&I\Ipl !'f.be --n Sn .9()V
<br /> APPLICANT NAME: RFff �JC c E(,1 Co m pfin
<br /> APPLICANT MAIUNG ADDRESS: STREET ?O [ OX I5? 1
<br /> CITY rn Ar LAS l 1-P` STATE 1A- zip /7-7
<br /> APPLICANT PHONE:: (&5' 'jD f5 PUCANT EMAIL:
<br /> PRIMARY CONTACT: 0 OWNER XAPPUCANT ❑OTHER(Architect,Engineer,Etc.)
<br /> CONTACT NAME: CONTACT PHONE: alb to i O 0
<br /> Af,...y) � few c n CONTACT EMAIL: J(�Sl1 em re ___an +Yu� cn.C.o n
<br /> ACKNOWLEDGEMENT::f 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 eutho ted 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!comply►ith the State Contractors Law 18.27 RCW end 298.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> PW ) OZ - S
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
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