631 107TH ST SE 2017-06-07 - Laserfiche WebLink

PI BLIC WORDS PERMIT " PLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov Www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 'A 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 ❑YES,TYPE SIZE SITE WORK I RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: CKq 14, ❑ 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 CONTACT INFORMATION OWNERNAME: ` O ; �\ E. OWNER MAILING ADDRESS: STREET CIN "/ ��: STATE ZIP L OWNER PHONE: OWNER EMAIL: APPLICANT NAME: APPLICANT MAILING ADDRESS: STREET �h G CITY STATE Z] ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT:,111OWNER ❑APPLICANT ❑ OTHER Architect, Engineer, Etc. CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: 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 1 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 98.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# L4 I-Z5� PW16C�-- c)s46 Owner/Au ori d Agent Signature D to (Revised 90/92/2015)