2701 12TH ST 2020-05-19 - Laserfiche WebLink

L/rnk 't 0 hr►mI'1 %.0V —1a,IQ4. Se It- . 7/ 9 , P1oLIC ' `V0, RKS PERMIT PLICATION Ss.,---A CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2..7Q 1 / z.'''' -TIZ T ENErFT4 IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) ��,// SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX LVMULTI-FAMILY ❑COMMERCIAL El INDUSTRIAL CHANGE OF USE? S NO ❑YES, FROM �� TO - NEW WATER/SEWER SERVICE NEEDED? LK NO ❑YES,TYPE SIZE SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION RMATION DESCRIPTION OF WORK: £ i, i h1 f) /' 1.4 9 C y‘If elt f� /C P(1---k,,i5 L tic A-L L Coh:C.r-c... e_ S S 40 M It i' .24 ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE NS/ASPHALT/CONCRETE PAVING L/`f000 A-.5V.. t-� SF 1`-{ 2-00 .SIt.�Nu.:,#tI....�_5 (c0��+C- �- ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑ CLEARING/GRADING/FILL/EXCAVATE CY 0 CUT/BORE IN PAVEMENT(PARALLEL) LF ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION q OWNER NAME: EVE /ki Ti-- HO LS i;1'�''�6i / u I A1-10 i rJ OWNER MAILING ADDRESS: STREET 3 l C 1 Co/ 13 > /...-F ` ., CR �� Y G r E 1`E-/ I •J STATE ,JY\ ZIP 90 OWNER PHONE: OWNER EMAIL: APPLICANT NAME: APPLICANT MAILING ADDRESS: STREET S(] C 45 A-196 VL— CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: 0 OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: V/2.5) 2-; 3 - S)/ 3 /Ex : 6,NQ y 2,,---,-)Dii tlrJ ,- CONTACT EMAIL: re,i,l.. 0 Li 1, eIL e V i-14 L2 iZG ACKNOWLEDGEMENTave reviewed this application and confirm the information contained herein is ti 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/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# 4...k-,---- 6 - 1 - / 7 PW I70 -o44- Owner/Authorized Agent Signature Date (Revised 10/12/2015)