3002 16TH ST 2017-06-07 - Laserfiche WebLink

P" II)LIC WORKS PERMIT -." "PLICATION CITY OF EVERETT PERMIT SLKVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 ( (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: IF APPLICABLE: M LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) SITE WORK FOR PROJECT TYPE:E]SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL O' CHANGE OF USE? NO ❑YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? NO ❑YES,TYPE SIZE SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: C� C/• / 11C dFFENCE IN ROW �Z `� FT IN HEIGHT LJ DRIVEWAY APRON/CURB CUT J FT WIDE 9rD/ASRW,L,T/CONCRETE PAVING -5,00 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 CONTACT INFORMATION OWNER NAME: Ze//'-e OWNER MAILING ADDRESS: STREET CITY STATE ZIP G U OWNER PHONE: OWNER EMAIL: APPLICANT NAME: ��/�.,> cr , �• �l APPLICANT MAILING ADDRESS: STREET pp G e�'�3 c/ �• J CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: WNER ❑APPLICANT ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: d r �� I 'e'f'r-( CONTACT EMAIL: `o ff/ !ZfoZ G� Cd ACKNOWLEDGEMENT:I have reviewed this appli ation and confirm the information contained herein is tr e and correct. Work done pursuant to this permit must comply with current federal,state, and local law. T e 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# Z f� PW Owner/Authorized Agent Sign re Date (Revised 10/12/2015)