2514 51ST ST SW 2019-09-10 - Laserfiche WebLink

PLIC WORKS PERMIT PLICATION I�►� _ CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 (E) everetteps@everettwa.gov I www.everettwa.gov/permits r„1111013C � r . � � .a. r ..aiNtkms � '3 I... tt "441111125. ., g PROJECT ADDRESS: 257 4- - 5/-St- IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) SITE WORK FOR PROJECT TYPE:J SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY DCOMMERCIAL ❑INDUSTRIAL CHANGE OF USE? NO ❑YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? )4 NO 0 YES,TYPE SIZE s rs r� t r � a.a>c^.«a rmk��.n�� zG�� :.�. .� e.ws�r-' �k .,� 'K`°7,� k�� x 4 } 10111A -T*571 GHTb,OF-s _ 4076-ICA7TI/OWN 1!NFO,RMATI.ON _, � i 1 DESCRIPTION OF WORK: e) Pr{Lie d i--,V�1,i .�/ t.'u 1-41 ( ) Y)cr e'*e ❑ 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 ONTACT INFORMATION � � ._..__,. OWNER NAME: r f2 W 1Y12.-1) 14-43 ‘\)c OWNER MAILING ADDRESS: STREET 2_61 51 Th cv S W CITY &WI/Lx�� STATE kJ-A- ZIP ctO zy3 OWNER PHONE 425- 9-[se'3 OWNER EMAIL Wa- `0.SO Lo LptA-,\ APPLICANT NAME: SA--(k4 c� APPLICANT MAILING ADDRESS: STREET CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: 0 OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: 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.I am the owner,or I am 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# PW )703 - DI Owner/Authorized Agent Signature Date (Revised 10/12/2015)