2604 BAKER AVE 2017-02-24 - Laserfiche WebLink

/S-00 -.__ CITY OF EVERETT PERMIT LL'IIVICES ,/-20 ,' O S—03 Z ,,,--A - PI RUC VvOiwKS PERr\vilT .PDPLICATION �' 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwagov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: Z6,'/ "Lice y' PrAr 4-Ver"ii IN As 9 8.2.9 IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED El DUPLEX DMULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 0 NO 0 YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? ❑ NO ❑YES,TYPE SIZE SITE WORK J RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: 13t,d 1 A ' f;C i )11 k0 CO Til mak. y4f) FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ASPHALT/CONCRETE PAVING SF o 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 . OWNER NAME: �:::... e / CONTACT_INFORMATION OWNER MAILING ADDRESS: STREET 2.6.0 7 )4'& Y /1--v-c-- CITY ,61 f)"e�7 STATE 1 v ZIP 9 r2-e2/ OWNER PHONE: '/ 5I- 97/Q/7O OWNER EMAIL: APPLICANT NAME: KG{ RPIR---P APPLICANT MAILING ADDRESS: STREET aG(/ , ?/I r Ave, CITY ,VB)^c 7 STATE iv 4 ZIP ,87.4:7/ APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: I►' OWNER ❑APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: 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.I am 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# 5/2;7 g / o1 PW t 0 S - 63 Z e 0 2/2016 Owner Aut6on d Age Signature Date (Revised 1 /1 )