5009 SOUND AVE 2020-05-21 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION "id CITY OF EVERETT PERMIT SERVICES viii . 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION c U PROJECT ADDRESS: '� - 50,.,t ,( ( , iAR(pc F-1-- SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) IF APPLICABLE: 0 FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# DESCRIPTION OF SITE WORK/ RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: ❑ FENCE IN ROW FT IN HEIGHT ❑DRIVEWAY APRON/CURB CUT FT WIDE ❑ASPHALT/CONCRETE PAVING SF ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF 0 RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑CLEARING/GRADING/FILL/EXCAVATE CY *CUT/BORE IN PAVEMENT(PARALLEL) i ' — LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF ❑POLE WORK/AERIAL I OVERLASH LF ADDITIONAL DESCRIPTION(AS NEEDED): CONTACT INFORMATION OWNER/APPLICANT NAME: r N'--\ VIA.(//4-14:C., OWNER/APP. MAILING ADDRESS: STREET �{/ 1 qua-- LI D .t---- rem- CITY Gy hvrc t..)7 U c..k ---STA_TE w4- ZIP q OWNER/APP.PHONE: S -qc -��(, OWNER/APP.EMAIL: "Z�C�-1'i� 4'rki.GrA^Sev c cc. , /CY---1 CONTRACTOR NAME: ViA,g,-47>e Cep^S t- `"i iok...A..) CONTRACTOR ADDRESS: STREET se-t-irt."-e_ CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): I EVERETT BUSINESS LICENSE#(,REQUIRED): PRIMARY CONTACT: 0 OWNER /APPLICANT CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: (49-6--14) e'-4-/-6 /6 i f aro ts- V('l\✓'(-'-Iti€,_ CONTACT EMAIL: 0.1�f 'Yc`� 7. j14g./ - . evr iS7-✓t_C � , Cc 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.lam the owner,or I am authorized by the owner of this property to perform the work f which application is made,and I comply with the State Contractors Law 18.27 ROW and 296.200A WAC. City of Everett Official Use Only PERMIT# I toc17-(K PW IVO -©y4 Owner/Aut orized Agent Signature Date (Revised 1/52017)