420 85TH PL SW 2022-03-04 - Laserfiche WebLink

44.7"T PRLIC WORKS PERMIT A'LICATION 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 /l r� PROJECT SITE INFORMATION PROJECT ADDRESS: ( 257 /P(--- ,5 e'i SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY OCOMMERCIAL ❑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 CY ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF ❑ POLE WORK/AERIAL/OVERLASH LF ADDITIONAL DESCRIPTION(AS NEEDED): /E .--,2-/tip f? �/.)l -G.s `2/i//t /3/777N / 7 -- f CONTACT INFORMATION OWNER/APPLICANT NAME: ALV -oAP-7J0JoP( a�� / / ,( OWNER/APP. MAILING ADDRESS: STREET //f 12u j�r/i7I,t A-ti, / . f /0 2- 7 �/ CITY /—7- t STATE G'v �� ZIPP I�� I OWNER/APP. PHONE: 2 '7 2-- 0O- ,' OWNER/APP.EMAIL: AA/z JC)/ 1. G i 201f21)6 r //'mil CONTRACTOR NAME: Aigf/0 Al ie7G/G CONTRACTOR ADDRESS: STREET ‘ ,C7 GIl jA/C. IL/U /GN/),Z trfOS CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: L37C42JGL-N./`/ WW/U/2.00 -/2/f-4711 CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: >(OWNERCAPPLICAN1 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 'g_06... . 'f., 0 - eV , — CONTACT EMAIL: f A .j)A/- it.2C72U_f fW r `�/z / 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. I am 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# DP PW g CO - 0Sc Date (Revised Owner/Authorized Agent Signature 1/52017)