Laserfiche WebLink
Amp <br /> PUR.IC WORKS PERMIT API LI TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> :PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3 6 3 civ ,fav e 6:71Pa' i 'A qg 20 <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? ❑NO ❑YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: /fie c�ivy In cl U 0.- 6e, <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 /> Q RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> 0 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: <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> APPLICANT NAME: Lwke_ Shaws-e Oww C011k LL G <br /> APPLICANT MAILING ADDRESS: STREET ,fin 1A-tar$ Cyrt-S Way A <br /> CITY /1'`v1 F\t.4 STATE w ZIP q s,2-7 c <br /> APPLICANT PHONE: 'APPLICANT EMAIL: <br /> PRIMARY CONTACT: 0 OWNERLEAPPLICANT 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: } CONTACT PHONE: Yas-.. �j' 6 1, 3 oZ` <br /> Zwkt_ Step. CONTACT EMAIL: AA. ,..14,5 1te_61,t^tQf t.kk.k l / L r C°14/L <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 /> 409 703 PWW 1'BOLH 005 <br /> Date (Revised 10/12/2015) <br /> Owner/Authorized Agent Signature <br />