Laserfiche WebLink
P!��:I� W��.�� ��G��I�' ������`����➢ <br />CITY OF EVERETT PERMIT S�t-ZVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everetfwa.gov � www.everetfwa.gov/permits <br />. _ _ - . - . _ . -. ,_:_ _ .,.,. <br />. , _. <br />: _ <br />- <br />,. <br />__ . <br />�: : : - PROJECT SITE INFORMATION <br />_ _____ .__ :._. _ __. .. _ ._._ .__ . ._ , _�._ _ .._ ._._ <br />PI20JECTADDRESS: �G � r ��%e. L vere <br />IF APPLICABLE: ❑ LAND USE PROJECT# (SEPA, PRE-APP, SS, ETC.) <br />S(TE WORK FOR PROJEC7 TYPE: L75FR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY <br />CHANGE OF USE? I�Q NO ❑ YES, FROM TO <br />NEW WATER / SEWER SERVICE NEEDED? l�l NO ❑ YES, TYPE <br />COMMERCIAL ❑INDUSTRIAL <br />SIZE <br />_ = � . . ...:. _. <br />_ ,. <br />' SITE WORK I RIGHT-OF-WAY APPLICATION INFORMATION , <br />DESCRIPTION OF WORK: ��l_� 1- O <br />�� <br />[� FENCE IN ROW �� FT IN HEIGHT <br />❑ DRIVEWAYAPRON / GURB CUT FT WIDE <br />�. ASPHALT / CONCRETE PAVING SF <br />❑ REfAINING WALL / ROCKERY IN R1GHT-OF-WAY LF <br />❑ RETAINWG WALL! ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br />$I CLEARING / GRADING / FILL / EXCAVATE �� S F CY <br />� CUT/BORE IN PAVEMENT (PARALLEL) LF <br />� CUT/BORE IN PAVEMENT (NON-PARALLEL) LF <br />_ . •. _. _ _ <br />.,. . . <br />'' ' _ CONTACT, INFORMATION. . <br />OWNER NAME: C � {� <br />OWNER MAILING ADDRESS <br />ER PHONE: I'�I acc.7 ' � <br />STREET <br />cirv <br />�_Qi <br />APPLICANT NAME: � 5/(�( f� L[ �L /� <br />APPLICANT MAILING ADDRESS: STREEf � � ,' <br />crrY � �% f' <br />I� C���--��/e• <br />STATE U% i9: ZIP ��„� D <br />OWNER EMAIL: <br />_�....._.,__..�_...� _,..,._.,.� <br />� �7_ C�- <br />12 1 I/`' 1L' f� Y %� �/ P: <br />STATE Iii% i% � ZIP <br />APPLICANT PHONE: - ��, �D - �' I APPLICANT EMAIL: <br />PRIMARYCONTACT:x�� OWNER � L�APPLICANT ❑ OTHER (Architect, Engineer, Etc.) <br />CONTAGT NAME: =�j /l�/Q �Z (rL�%q/� eZ CONTACT PHONE: � �S _ S� - —1 <br />CONTACT EMAIL: <br />ACKNOWLEDGEMENT.� I have reviewed fhis application and confirm the informafion contained herein is frue and correct. Work done pursuanf to this permit must <br />comply wiih current federal, staie, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must firsf be <br />authorized in writing from the Building Official 6efore 6eing authorized under any circumstance. l am the owner, or 1 am authorized by the owner of this property to <br />perform the v✓ork for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett O�cial Use On/y <br />PERMIT # <br />�'",� b� �a� �� Pln/16�� ��� <br />s <br />OwnerlAuihorized Agent Si ature Date (Revised 10/9?J2015) <br />