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____________ _ PUIC-WORKS-PERMIT ALICATION <br /> - :,.._----- .a.,.--. --=r.-. -.. ._... CITY-OF`EVERETT PERMIT-SERVICES-_ _:: _ :::,. — , - _ -_.-. -,,.,. . _.. <br /> 3200 CEDAR STREET EVERETT WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> -PROJECT-SITE-INFORMATION- <br /> PROJECT ADDRESS:6103 ROCKEFELLER AVE SE <br /> IF APPLICABLE: O LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:.O SFR-DETACHED.. ..O SFR-ATTACHED O DUPLEX- O MULTI-FAMILY-..-O COMMERCIAL <br /> CHANGE OF USE? O NO O YES, FROM TO <br /> NEW WATER/_SEWER SERVICE NEEDED? O NO O YES,TYPE _. SIZE <br /> __. SITE_ltl[ORK[_RIGHT OF-WAY_APPLI_CATION;INFORMATI.ON. ,_T _____„- .--- <br /> DESCRIPTION OF WORK: FENCE IN RIGHT-OF-WAY ••- S&E Si plQri `1Qr A/Ids' <br /> O FENCE IN ROW Vri&A/ FT IN HEIGHT <br /> O DRIVEWAY APRON/CURB CUT FT WIDE <br /> =ASPHALT/CONCRETE PAVING SF <br /> O RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> O RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> o CLEARING/GRADING/FILL/EXCAVATE CY <br /> O CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> O CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: PETERSON DEAN <br /> OWNER MAILING ADDRESS: STREET 23109 LOCUST WAY <br /> cui BOTHELL STATE WA ZIP 98021 <br /> OWNER PHONE:2067862635 OWNER EMAIL: LAKEPOINTEMETALS@COMCASTNET <br /> APPLICANT NAME: PETERSON DEAN <br /> APPLICANT MAILING ADDRESS: STREET 23109 LOCUST WAY <br /> an, BOTHELL- —_ _.STATE WA — Z1e 98021 <br /> APPLICANT PHONE: 2067862635 (APPLICANT EMAIL: LAKEPOINTEMETALS@COMCAST.NET <br />..-= PRIMARY-CONTACT: -='OWNER' 0 APPLICANT -O OTHER(Architect,Engineer,-Etc.) .- --- -----• ' _-. <br /> CONTACT NAME: PETERSON DEAN CONTACT PHONE:2067862635 <br /> CONT-AC-T-EMAIL-:—LAKEPOINTEMETAL-S@COMCAST.NET -- <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 wo .r which pplication is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> . 2 , (a - i <br /> City of Everett Official Use Only <br /> 7° PERMIT# <br /> ( PW1902-012 <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br />