1208 100TH ST SW 2017-08-03 - Laserfiche WebLink

P�LIC WORKS PERMIT �I�PLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: � �^, g (;� �— ;SvJ 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? �F NO ❑ YES,TYPE SIZE SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: L;C.t) j F- ❑ 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 6�7�`'��- ,, ❑ CLEARING/GRADING/FILL/EXCAVATE CY � (�c.��+- Q� �L'i" . ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF /j�l "i 0 7,�� `t CONTACT INFORMATION OWNER NAME: —� CI�C� �J d'C)�'C��3 �jb�V1c`� OWNER MAILING ADDRESS: sTREET 2 � t� I-�-� �C CITY U�� S�` ��` STATE �/`-'V /' ZIp l �� C`�' OWNER PHONE: �Z��Z cv`'Z OWNER EMAIL: UE'l �C(C,�C Vv v��IF'!7`�� (U�til APPLICANT NAME: � � —4 Cl C� C � �C �'l� �y'"�� 't'G�P%S '["V�MPS APPLICANT MAILING ADDRESS: sTReeT � Z � '�-`� •'-�1�� r(,�(,- CITY CT� � �V S �� STATE � ZIP 4' � �� APPLICANT PHONE: APPLICANT EMAIL: � �� w C�C; C� ��'� !`^S� C C'��I PRIMARY CONTACT: I�OWNER �APPLICANT ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: '`�Z S� Z�� 2 � Z � _ �;;`E' � �•—��l �� CONTACT EMAIL: � L�e� �.��c� c< < � Jre�-�1F►S �C C_��M ACKNOWLEDGEMENT:I have reviewed this application and confirm the information containe erein 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 Otficial before being authorized under any circumstance.1 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 RCW and 296.200A WAC. City of Everett Official Use Only � PERMIT# � �; �.�.�'' � �� -� � PW i �6C�- ��1 1 Owner u orized Agent Sig ure _ Date (Revised 10/12/2015)