2910 TERMINAL AVE 2017-07-17 - Laserfiche WebLink

Pl___IC WORKS PERMIT PLICATION CITY OF EVERETT PERMITS ES 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 PROJECTADDRESS: iNFLrj_5;c_TwJ O ,:0)c,"L AVGs 4 -re-P- AIAJAL� AVE C:V82eT-r in/A IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) ��,�� SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑ I� COMMERCIAL INDUSTRIAL 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: 100 LF OF URS ptJD 6,tJg01- 6PL-AGl✓0✓a1N-r AL-o►�)U EAS-- 117 0 r -Tel AA 11J A(- A\19 CVE2�:T T A. Cu)tJ i iZA(.-rJ1 Z, LV i/-L Fa LC,ew Ak 0-,C)� S-T 4 N)UklFog- CoN-7k_6L_ AN1 s C(-Ty 0r- EVaR,6-TI S-TANOAILI) 505-A Fvl2 Cu2Lj iMSTA%.L ❑ 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 OWNER NAME: ant 5� R-4ILwA� eJ. C 0 '(A' L0(2 SM 1-7-N OWNER MAILING ADDRESS: STREET L-yS`f 0CC jbj INTQL AVL 5 LfITs Z �) J CITY 5 L1ArT L(' STATE WA zip la(-6v OWNER PHONE: LO(o ' (o'L5- (1,325G OWNER EMAIL: ' /o!• ern J�GP LA Sf.. c-oA^, APPLICANT NAME: j2(_--cs 2 bb Z ltJ APPLICANT MAILING ADDRESS: STREET f 71 SC 2 4u 5-T 2-0 0 rT/Ce �q,� CITY '6t'L1_CVU� STATE WTD zip p Eos APPLICANTPHONE: yZ5-Zu5-S(( ( APPLICANT EMAIL: GO�,✓i hah5on- 'nL,Co+� PRIMARY CONTACT: ❑ OWNER APPLICANT ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: S Ns APPL1c AtJ i CONTACT PHONE: 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 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 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# PW Owner/Authorized Agent Signature Date (Revised 10/12/2015)