6121 BEVERLY LN 2016-07-29 - Laserfiche WebLink

P LIC WORKS PERMIT APPLICATION °1101117—ab A/ _ 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 www.everettwa.gov/permits PROJECT; SITE' INFORMATION- Jy PROJECT ADDRESS: 6 /2 ffe p ty AzZ IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) �� SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED iffEUPLEX 0 MULTI-FAMILY ❑COMMERCIAL 0 INDUSTRIAL CHANGE OF USE? lJ NO 0 YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? ®NO ❑YES,TYPE SIZE SITE WORK'r/'RIGHT�OF,:WAYAPPLICATION INFORMATION K fif DESCRIPTION OF WORK: NI/FENCE IN ROW '/2",- ,' ,L- P. FT INHEIGHT ❑ DRIVEWAY APRON/CURB CUT 1� 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 CONTACT INFORMATION, OWNER NAME: I tl E ri,O.s''icr G lie?(i 1? OWNER MAILING ADDRESS: STREET 51-(f2 (G72"'-'' 5'7: 57ty CITY Z-rV,r V Y 6 STATE w ZIP �g� OWNER PHONE: '2_06 32 ‘c--6--7 OWNER EMAIL : 6 f APPLICANT NAME: f cWi G� In 01- �__ .. _ n.� �_ .. APPLICANT MAILING ADDRESS: STREET zf j r7� S T CITY E-411/2/7 v[/7 OOG STATE VA r79 ZIP CIS D-37 APPLICANT PHONE: -'5' �� 6'7 'APPLICANT EMAIL: PRIMARY CONTACT: TOWNER la'APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: eiptiagi lgrA CONTACT PHONE: CONTACT EMAIL: 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.lam the owner,or lam 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# PW /60 2-- o7--6. Owner/Authorized Agent Signature Date (Revised 10/12/2015)