10707 9TH DR SE 2017-05-17 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: :--1- t �C 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? ❑ NO ❑ YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? ❑ NO INL-YES,TYPE SIZE . SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: w Sri �z, ❑ 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 A CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: STREET _ 7+ CITY V �. STATE ZIP OWNER PHONE: OWNER EMAIL: APPLICANT NAME: APPLICANT MAILING ADDRESS: STREET 7 CITY h STATE ZIP 961 - APPLICANT PHONE: APPLICANT EMAIL: rV O d PRIMARY CONTACT: ❑ OWNER ISrAPPLICANT ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: /)' CONTACT PHONE: ,,( t CONTACT EMAIL: 60olI Ll ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. VVQrk 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. l am the owner, or l am authorized by the owner of this property to perform the work for which application is made,and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# h -- � � PW •� Owner/Author) Agent S' ature Date (Revised 10/12/2015)