Laserfiche WebLink
eiv <br /> PiiPILIC WORKS PERMIT APPLICATION <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: Ag 24.. ciQ ayir Av.(, <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 'MULTI-FAMILY ❑COMMERCIAL 0 INDUSTRIAL <br /> CHANGE OF USE? RI NO ❑YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE <br /> SITE WORK I RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: A'07ae.. ah A lbe-4/."ezt A, 2-i-e `?"f'Gfrill i' ze,/ AR-!'Y�/1'l"-cyt <br /> /°t/,41,leu <br /> eraeL,A, LI 47Ai71t4 it/iw ciseap, <br /> v) <br /> ❑ FENCE IN ROW FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> ❑ASPHALT/CONCRETE PAVING SF <br /> 0 RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> 0 RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> CI CLEARING/GRADING/FILL/EXCAVATE CY <br /> 0 CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: JaW1C4 A14.epi 404..,-AoiG Ind/• 541 ''// <br /> OWNER MAILING ADDRESS: STREET /L'�j /:J( ink�-b°.2z ( c-a �1"•/ Len -///7 I /��± <br /> CITY t Pr are y' STATE a /4-- ZIP %rJ,t C5 <br /> OWNER PHONE: ` OWNER EMAIL: <br /> APPLICANT NAME: „�H.. m1^t L/�1t i-t- <br /> APPLICANT MAILING ADDRESS: STREET $DJ 5r 1-1-4,-1;4 el Si-, <br /> CITY Se4,74/e STATE 14 zip /G/L <br /> APPLICANT PHONE:abb' 3rb,`t - itipp APPLICANT EMAIL: AyllCiieile �ehor-j-e/'tf�A �e0 <br /> PRIMARY CONTACT: 0 OWNER FAPPLICANT ❑OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: / CONTACT PHONE: �a j,— ti l 3—(,7 4>27 <br /> /hirl-- 4/l PIl4-/ti CONTACT EMAIL: 44.1t el it'„&ohkr`.tet-t,Oki ,10141 <br /> ACKNOWLEDGEMENT.'I 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 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 /> 7„..,..0 e..-.- ' `i ' / P 1a ,&, -O3 <br /> _......c...... .•.L_04S <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />