7601 EVERGREEN WAY BASE FILE 2019-09-05

• s LIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 Ole"' (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 7(0o/ [=VEVA 2Eb-7),, CAM -( SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY COMMERCIAL El INDUSTRIAL IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS,ETC.) IF APPLICABLE: 0 FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# DESCRIPTION OF SITE WORK/ RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: ❑FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ASPHALT/CONCRETE PAVING SF ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑CLEARING/GRADING/FILL/EXCAVATE CY ❑CUT/BORE IN PAVEMENT(PARALLEL) LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF ❑POLE WORK/AERIAL/OVERLASH LF ADDITIONAL DESCRIPTION(AS NEEDED): P&p ln-c.e.t. ►r of FM lam, 1 )scv Q At Ltnttj VA-t eA W s' N>rw S" tecu A aka-, IA); I( bA CelaTtFt�ro w42.1^AIkAM-1...) CONTACT INFORMATION OWNER/APPLICANT NAME: FzR.t< t�L OWNER/APP. MAILING ADDRESS: STREET1//1��Of .t 2I C RAAE7Z Rb K p CITY C-'ll E� gma./4j02_ STATE (u/- ZIP 9 E-3'Z^i OWNER/APP.PHONE: 2S - t - - Zos(. OWNER/APP.EMAIL: ICe@_ CAIFAAc.ft,p;,,. CONTRACTOR NAME: ETM jaAcb FIRE t t C- CONTRACTOR ADDRESS: STREET ,/ku2L CJ A CIL. RN, t�P, CITY C1. 14A(e_/34OfZ ,WA- STATE II/I ZIP 9ct Cie CONTRACTOR PHONE: 2.S3-si►S7-20 SZ CONTRACTOR EMAIL: VA i4�d1 t� TE4,60Ac-I citQ LlC.Certe CONTRACTOR LICENSE#(REQUIRED): Z e a R.Gi to S.A.1?-- EVERETT BUSINESS LICENSE#(REQUIRED): •7111 ct PRIMARY CONTACT: 0 OWNER /APPLICANT K,CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: t CONTACT PHONE: zs' , 606. 12/7 £rTH It 4�STRo s CONTACT EMAIL: 4 444 e_ aueg44.4F fa p `�C. A-1 ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must 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 authorized in writing from the Building Official before being authorized under any circumstance.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# •' r ' - iY PW1811- 02. 6 Owner/Authorized Agent Signature Date (Revised 1/52017)