2521 MONROE AVE 2017-08-24 - Laserfiche WebLink

PALIC WORKS PERMIT AMPLICATION CITY OF EVERETT PERMIT SERVICES 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 �/19 PROJECT SITE INFORMATION PROJECT ADDRESS: Fj /v`Q I\J R0 E e J U 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/ RIGHT-OF-WAY((APPLICATION INFORMATION DESCRIPTION OF WORK: El FENCE IN ROW FT IN HEIGHT DDRIVEWAY APRON/CURB CUT FT WIDE E 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 yCONTACT INFORMATION OWNER NAME: A A R CI A J2.E� 01�•'Li✓l`� OWNER MAILING ADDRESS: STREET Son !V �) CITY r STATE V v A ZIP OWNER PHONE: 6 - 3_ — Q 9 LL OWNER EMAIL: M le I L' E F70 VE, APPLICANT NAME: J D H U NlT PA V I N APPLICANT MAILING ADDRESS: STREET S/6 i LDc-f h Sr vu }/� j µ1 CITY V L I 11 STATE V "/ ZIP APPLICANT PHONE: JAPPLICANT EMAIL: PRIMARY CONTACT: 'OWNER ❑APPLICANT ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: A,K r--){ -CE:` - FO-W LEP_ CONTACT EMAIL: ACKNOWLEDGEMENT:I ha viewed this application and confirm the information contained herein is true and correct. Work done pu ant to this permit must comply with current federa, state,land local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be auth rued in writing fro the Building Official before being authorized under any circumstance. I am the owner,or I am authorized by the owner of this property to pert -m the work for w ich a 'lication is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# �a 1 PW Owner/Authorized Ag n ignature Date (Revised 10/12/2015)