2617 98TH PL SE 2020-06-19 - Laserfiche WebLink

PBLIC WORKS PERMIT A'LICATION grr 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 https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 26,11 '61-14- pZ• .. fy T mfr1- qg205 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED CI DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL 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 0 ASPHALT/CONCRETE PAVING I/O() 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 0 POLE WORK/AERIAL/OVERLASH LF ADDITIONAL DESCRIPTION(AS NEEDED): CONTACT INFORMATION OWNER/APPLICANT NAME: I—e- JP 14 &i'p/l)G' � OWNER/APP. MAILING ADDRESS: STREET 261 7 y�q /yi pc- _ /� CITY -U -- ' STATE WA ZIP wzo6 As. p��r�j 22 OWNER/APP.EMAIL: �,� ) (/� J OWNER/APP.PHONE: �� ,5� C/U�J ��i�-i��"(l7 � tforptkfG: CG'm CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: DOWNER /APPLICANT 0 CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: tt1 /�� CONTACT PHONE: 2©(0 — z(3,5--- 7,j- 0E3,33 NN U /`)a CONTACT EMAIL: � C:X @,.44-0—t~H4`I L , cop! 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 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# l. ; t( I ( f PWI$II - 015 Owner/Authorized Agent Signature Date (Revised 1/52017)