4328 FOREST DR 2021-11-03 - Laserfiche WebLink

lit PLIC WORKS PERMIT ALICATION Mi• 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 https://everettwa.gov/permits Y PROJECT SITE INFORMATION PROJECT ADDRESS: 43ZJ v,Qdtf Di N'L 7 gere3 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL El INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) IF APPLICABLE: ❑ 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 ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑CLEARING/GRADING/FILL/EXCAVATE `3 lb%{ y kab S CY ❑CUT/BORE IN PAVEMENT(PARALLEL) LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF ❑ POLE WORK/AERIAL/OVERLASH LF ADDITIONAL DESCRIPTION(AS NEEDED): R ftw' '3 T-0 y)l4-Q 0.5 O D 2. Ia-c"" 8P A A K, ReseAJ trZ7.,/ E-r4-45 S , nL 2 c une �i�rFsatttdie7c.r7-( CONTACT INFORMATION OWNER/APPLICANT NAME: �C S E C. i.-E . OWNER/APP. MAILING ADDRESS: STREET 4 3 2g.' Pa �y CITY STATE ZIP OWNER/APP. PHONE: zaS 76.v.- 777l OWNER/APP.EMAIL: CONTRACTOR NAME: (1,S'f'2V'V ' .S `Ucs. - t,t)&s+ CONTRACTOR ADDRESS: STREET 7 S 10 E 1-1-coitlfy v AJ ' / CITY l(Q,0( y4`µ" /STATE�Q ZIP q0//-6�3j CONTRACTOR PHONE: 7 // CONTRACTOR EMAIL: f-A e)/(9 et .,_pv-4 c C())).-/k CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): 7©q3 2 PRIMARY CONTACT: 0 OWNER /APPLICANT ❑CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: J tPF (/►ret RS)N P CONTACT EMAIL: ACKNOWLEDGEMENT:1 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.1 am the owner,or lam authorized by the owner of this property to perform the wort or` hich application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. f\ City of Everett Official Use Only PERMIT# Ilt \ PW /80?- c/2 Owne'Auth, ize. Signature Date (Revised 1/52017)