11323 EVERGREEN WAY 2017-05-23 - Laserfiche WebLink

f "A. Pu LIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 FAX 425-257-8857 i (E) everefteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: %/. 3 Avy/1v9zJIFAPPLICABLE: ❑ 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 [4 YES, FROM 6'Cf-F- f SM Alh TO 1-:57() L' NEW WATER/SEWER SERVICE NEEDED? ❑NO ❑YES,TYPE SIZE �"XrS7iAf�` SITEMORK./RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: � '�r�Cr r'�l?j�7�ccf /�1 f:J'T `�.�/'Tr4/.�l R l..f r F riGL' 9-1 ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT Z a FT WIDE ❑ASPHALT/CONCRETE PAVING SF x D SEP U 6 2016 11 RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF J ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT C I TY OF EVERETT ❑CLEARING/GRADING/FILL/EXCAVATE CY Permit Services ❑CUT/BORE IN PAVEMENT(PARALLEL) /`7t? LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFOR'IMATION 7 OWNER NAME: " " S C_l C S7 lbs/ 4"e—"LVt— OWNER MAILING ADDRESS: STREET f�Z>. fir x X75 5'z — CITY CITY p sT�"Is//�t I L L�`. STATE L A ZIP 9e tl l-z_ OWNER PHONE: 0iCy., 38 4;&1? OWNER EMAIL: APPLICANT NAME: APPLICANT MAILING ADDRESS: STREET CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: )6-QWNER ❑APPLICANT MUNOTHER(Architect, Engineer,Etc.) CONTACT NAME: CONTACT PHONE: 57FVEJJ J�- �'L��7C1,'W- CONTACT EMAIL: ACKNOWLEDGEMENT.'1 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 application is made,and 1 comply with the State Contractors Law 18.27 RCI`and 296.200A WAC. City of Everett Official Use Only PERMIT# Pw/�-c cli Authorized Agent Signature Date (Revised 10/12/2015)