1218 GRAND AVE 2017-05-24 - Laserfiche WebLink

P1 LIC WORKS PERMIT PLICATION 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: (—'cul(i J IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED MSFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? JI NO ❑YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? ;t�NO ❑ YES,TYPE SIZE SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: \C'W�ov Vl � 'ljj �_O � �� 7�"d�1VJ� Si>\�.(\c�G W✓� _ ,fC.n 6� C.n�'j �'E✓� v � T�Vt� � . ❑ FENCE IN ROW FT IN HEIGHT FT WIDE ❑ASPHALT/CONCRETE PAVING SF UU D El RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF El RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIG APR 12 2016 0 ❑ CLEARING/GRADING/FILL/EXCAVATE CY CITY OF EVERETT ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF Permit ser - r -S ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: STREET CITY - ��-� - _ - STATE ZIP OWNER PHONE: — (� �\ CQ OWNE//R `K0 EMAIL: & 0�2 C>t I [ U APPLICANT NAME: t �v1 C1V1 f>A �'v 1 '-7 V;61'e7 APPLICANT MAILING ADDRESS: STREET l dO Z? Z� 1 CITY yam,- �",\/d C1 cl STATE ZIP �1 APPLICANT PHONE: L –77 `- � j I APPLICANT EMAIL: 1 ' ��L 01/1 o CSO 1M PRIMARY CONTACT: ❑ OWNER PPLICANT ❑ OTHER(Architect, Engineer, Etc. CONTACT NAME: CONTACT PHONE: - VV1 l�� CONTACT EMAIL: � �� Q \�'2 Cd V1 �U L�I �✓I � CEJ 1� ACKNOWLEDGEMENT."I have reviewed this application and confirm the information contained herein is tr fld 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. 1 am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# I PW 1604( O er/Authorized gen Signature Date (Revised 1011212015)