4007 FEDERAL AVE 2017-04-11 - Laserfiche WebLink

LIC WORKS PERMIT 7 :3PLICATIOIN CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: yDO FL-D45�9AI— AVE' �rr/�.tE�T A✓,'- IF APPLICABLE: ❑ LAND USE PROJJECT#(SEPA, PRE-APP,SS, ETC.) SITE WORK FOR PROJECT TYPE:R SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 1:9<0 ❑YES, FROM� TO e- NEW WATER/SEWER SERVICE NEEDED? L�1 NO ❑YES,TYPE SIZE SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: DAry ❑ 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 HAPR 14 2016 ElCLEARING/GRADING/FILL/EXCAVATE CY A ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF CITY OF EVERETT Permit Seri/it's,:= ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION OWNER NAME: L-L r A-.% e- • i OWNER MAILING ADDRESS: STREET r`�0O'�T ,QAC E vI Q9�1 22CITY CVEWE — STATE {��' ZIP 3J�� 9(J�oI OWNER PHONE: o - .333'8 U OWNER EMAIL: LodC_4Jrvl t h0"6!na►< <• r'l APPLICANT NAME: SO4"4 4 G A-301/C5 APPLICANT MAILING ADDRESS: STREET SAr"t AS AIZU vt CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: OWNER ❑APPLICANT ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 360. 333• $9-7-0 CONTACT EMAIL: WGW M t OJ Aa4 r,- A► . C o�+ 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 I am authorized by the owner of this property to perform the work for which ap kation is made,and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# / y,,n Ci c�— C' y�v �� PW Owner/Authorized Ag Signature Date (Revised 10/1212015)