2705 FOREST VIEW DR 2017-01-13 - Laserfiche WebLink

(P) 425-257-8810 P�LIC WORKS PERMIT �PLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECTADDRESS: ��I O S O ! � IF APPLICABLE: ❑ LAND USE PROJECT #(SEPA, PRE-APP, SS, ETC.) SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? L�'NO ❑ YES, FROM TO NEW WATER / SEWER SERVICE NEEDED? NO ❑ YES, TYPE SIZE SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION ESCRIPTION OF WORK: QFENCE IN ROW ❑ DRIVEWAY APRON / CURB CUT ❑ ASPHALT / CONCRETE PAVING ❑ RETAINING WALL! ROCKERY IN RIGHT-OF-WAY ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT ❑ CLEARING / GRADING / FILL / EXCAVATE ❑ CUT/BORE IN PAVEMENT (PARALLEL) ❑ CUT/BORE IN PAVEMENT (NON-PARALLEL) FT IN HEIGHT FT WIDE SF LF FT TOTAL HEIGHT CY LF LF CONTACT INFORMATION OWNER NAME: `� OWNER MAILING ADDRESS: sTREEr � CITY STATE ZIP OWNER PHONE: � ��'- �pD3 '' a. OWNER EMAIL: APPLICANT NAME: APPLICANT MAILING ADDRESS: srREEr CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: OWNER ❑ APPLICANT ❑ OTHER (Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: ACKNUWLtUGtMtN 1: 1 have reviewed th�s applica[ion ana connrm tne inrormanon containea nerem is rrue ana correcr. vvorK oone puisuam io �nis peirnn rnusi 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 Otficial before being authorized under any circumstance. 1 am the owner, or 1 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 # �� a.�a�� PW i�l�-d�� Owner/Auth zed Agent Signature Date (Revised 10/12/2015)