30 112TH ST SE 2020-05-06 - Laserfiche WebLink

CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P) 425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 112 S S IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL CHANGE OF USE? M-NO ❑YES, FROM TO NEW WATER!SEWER SERVICE NEEDED? rii,NO ❑YES,TYPE SIZE SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: Ain't) LyoM e St1 _ a k- , ❑ FENCE IN ROW FT IN HEIGHT E DRIVEWAY APRON/CURB CUT FT WIDE 0 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 CONTACT INFORMATION OWNER NAME: tpj givaer OWNER MAILING ADDRESS: STREET 36t' (n11 9a�y CITY G(JC)J U STATE k f ZIP 1 G( OWNER PHONE: OWNER EMAIL: APPLICANT NAME: APPLICANT MAILING ADDRESS: STREET CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: `OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACTPHONE: ' om CONTACT EMAIL: St•I (*.�4r.) awl ACKNOWLEDGEMENT. h „ave 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 1 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# %01. q\k C V-cA PW Owner/Authorized Agent Signa a Date (Revised 10/12/2015)