2310 116TH ST SE 2016-10-21 - Laserfiche WebLink

PLICATION CITY OF EVERETT PERMITPERMITS VICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 FAX 425-257-8857 (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 7LQ 14- '.-e az IF APPLICABLE: ❑ LAND USE PROJJECT#(SEPA, PRE-APP,SS, ETC.) SITE WORK FOR PROJECT TYPE:06R-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? ❑ NO ❑YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? ❑ NO ❑YES,TYPE SIZE SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: G� ❑ 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 CONTACT INFORMATION OWNER NAME: 2 OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNERPHONE: - 7 1 yy v OWNER EMAIL: e In c APPLICANT NAME: APPLICANT MAILING ADDRESS: STREET CIN STATE ZIP572� c5l APPLICANT PHONE: JAPPLICANT EMAIL: PRIMARY CONTACT: UKOWNER ❑APPLICANT ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: e - E �Qzz 4n ACKNOWLEDGEMENT.,l have reviewed this application and confirm the information contained heref is true and come . 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# 00 11 ner/Aut prize gent Signature Date (Revised 10/12/2015)