1809 HOLBROOK AVE 2017-06-02 - Laserfiche WebLink

P ILIG 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: ©/� V , 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? VNO ❑YES, FROM / TO NEW WATER/SEWER SERVICE NEEDED? 'Cle& ❑ YES,TYPE SIZE SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: �� oc— L SOK- 9Q2LoVAL OF AL V ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE ASPHALT I CONCRETE PAVING SF E E] RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ElRETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHTOCT 2 7 ��16 ❑ CLEARING/GRADING/FILL/EXCAVATE CY CITY OF EVERETT ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF Permit Services ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION OWNER NAME: S l l l F f A OWNER MAILING ADDRESS: STREET CITY /c STATE zip OWNER PHONE: OWNER EMAIL e_ 03(o rnAi l r wry APPLICANT NAME: SrStI�F�t{ ISS' c APPLICANT MAILING ADDRESS: STREET ac C J O V CITY '✓ , \� STATE " zip ! �n APPLICANT PHONE: 4q2 j �y (/ APPLICANT EMAIL: !7��1� 1, C'-) PRIMARY CONTACT: OWNER ❑APPLICANT ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: �� —3 13 ' yVCGNx)91 CONTACT EMAIL: !7?a C� 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 application is made,and I comply with the State Contractors Law 18.27 ROW and 296.200A WAC. City of Everett Official Use Only PERMIT# PWvj 16 1 o- 00l OwnerlAt orized Agent Signature Date (Revised 10/12/2015)