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

ilkLIC WORKS OMIT APLICATION CITY OF EVERETT PERM IT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFM,r tTION PROJECT ADDRESS: 4 S!/I/ IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE APP, SS, ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED EIDUPLEX O(v1ULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL CHANGE OF USE? NO ❑YES, FROM TO - NEW WATER/SEWER SERVICE NEEDED? ❑ NO ❑YES,TYPE SIZE SITE W• "K / IGHT-OF-WAY APPLICATI N INFORMATION DESCRIPTION OF WORK: 4,PD/ ✓G1 pn,,e#/' ❑ 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 _ a CONTACT INFORMATION — OWNER NAME: /1/SS/O4JAe,e-- . i►� �/L OWNER MAILING ADDRESS: STREET 4/C2 A/. 4 ,1•� 1- 5 //f7' 2/0 CITY/D,Jj'4 /// 4 STATE 42- ZIP��0O8 OWNER PHONE: 92 f_ 395-7Z.1'/ OWNER EMAIL: ,k411/7/44D ipsfivAl • eal-r APPLICANT NAME: 4 G V/PIz0 !//2,1D,v4, GAOJf Z I ,o. /4/i/ 4/2 APPLICANT MAILING ADDRESS: STREET 2 476 G,40f7 A N/: St,//1 Jo 2 CITY 3� Lt STATE 1N4 ZIP _1--D-__ APPLICANT PHONE: 2 0' -OQ6 APPLICANT EMAIL: `J4,2 0/VA' p rpfri PRIMARY CONTACT: ❑ OWNER lii<PPLICANT ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 2109v - 2 99 ,-00 6,4 GI/est P-U t o/v/J' CONTACT EMAIL: /f/Z� 11� 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# ,,,o .42 P` 503-0�°f Owner/Authorized Agent Signature Date (Revised 10/12/2015)