Laserfiche WebLink
PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 3525 LOMBARD AVE <br />IF APPLICABLE: [---]LAND LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) <br />SITE WORK FOR PROJECT TYPE: I—]SFR-DETACHED ©SFR-ATTACHED DUPLEX C--IMULTI-FAMILY E-ICOMMERCIAL <br />CHANGE OF USE? ONO o YES, FROM TO <br />NEW WATER / SEWER SERVICE NEEDED? O NO L--] YES, TYPE SIZE <br />SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION <br />DESCRIPTION OF WORK: REMODEL UPSTAIRS OF HOUSE AND TURN BASEMENT INTO A DUPLEX <br />I--] FENCE IN ROW <br />FT IN HEIGHT <br />0 DRIVEWAY APRON / CURB CUT <br />FT WIDE <br />F]ASPHALT/ CONCRETE PAVING 603 <br />SF <br />o RETAINING WALL / ROCKERY IN RIGHT-OF-WAY <br />LF <br />0 RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT <br />FT TOTAL HEIGHT <br />n CLEARING I GRADING / FILL / EXCAVATE <br />CY <br />ci CUT/BORE IN PAVEMENT (PARALLEL) <br />LF <br />C l CUT/BORE IN PAVEMENT (NON -PARALLEL) <br />LF <br />CONTACT INFORMATION <br />OWNER NAME: ALEJANDRO CARLOS & LEA MARIE <br />OWNER MAILING ADDRESS: STREET 3525 LOMBARD AVE <br />ctTY EVERETT <br />STATE WA zip 98201-5036 <br />OWNER PHONE: <br />APPLICANT NAME: rAppNamel <br />OWNER EMAIL: <br />APPLICANT MAILING ADDRESS: STREET [AppAdd] <br />CITY [AppCi] <br />STATE [AppStj zip [AppZip] <br />APPLICANT PHONE: [AppPhone] <br />PRIMARY CONTACT: Cl OWNER I] APPLICANT <br />APPLICANT EMAIL: [AppEmail] <br />0 OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: ALEJANDRO LEA MARIEICARLOS <br />CONTACT PHONE: 4252249541 <br />CONTACT EMAIL: BOWERS.LEA@GMAIL.COM <br />ACKNOWLEDGEMENT 1 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 taw. 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. l am the owner, or I am authorized by the owner of this property to <br />perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAG. <br />City of Everett Official Use Only <br />PERMIT # <br />PW1903-039 <br />Authorized Agenf/Owner Date (Revised 1011212015) <br />