5304 BEVERLY LN 2017-08-17 - Laserfiche WebLink

y� 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 . . _ L n PROJECT ADDRESS: IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) SITE WORK FOR PROJECT TYPE:OSFR-DETACHED bdSFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? NO ❑YES, FROM TO_ NEW WATER I SEWER SERVICE NEEDED? L (NO ❑YES,TYPE SIZE SITE 1i'iIORK I RIGHT-OF-WAY APPLICATION INFORMATIOM ! / ]/ DESCRIPTION OF WORK: �� '��ILi � I r /"I r] VeJA ❑ FENCE IN ROW FT IN HEIGHT ;KDRIVEWAYAPRON /CURB CUT FTWIDE ❑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 p CONTACT INFORMATION OWNER NAME: �(,( �G($5G, -f- �J'7� L U nfk7e)rn OWNER MAILING ADDRESS: STREET 67Ever-e_14— ��J/0 4-� � 1y 0__1tt eY I i ,n / J� CrrY CSV vSTATE VV 7r ziP E2O OWNER PHONE: 5-Z�('� O OWNER EMAIL: r/C�''IQ 5�4 2 Zf11 C Y�' �)I0c, CION) APPLICANT NAME: e I 'rv) APPLICANT MAILING ADDRESS: STREETr—V�1 DG 3 a4- �-eVP r")y L--� CITY !��-T t STATE A ZIP APPLICANT PHONE: �{Z��Zd/�"'�_8_2 APPLICANT EMAIL: C�YY7- PRIMARY CONTACT:` (OWNER ❑APPLICANT ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 426,2 qD , 9 ;?0 V 16js a L.Wid t izii'l-) CONTACT EMAIL: Veld- 45.5 -220 0 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 18.27 RCW and 286.200A WAC. City of Everett Official Use Only PERMIT# yd,tjua AV i PW wz- Owner/Authorized Agent Signature Date (Revised 10/12/2015)