5314 BEVERLY LN 2017-09-07 - Laserfiche WebLink

PALIC WORKS PERMIT AI'LICATION 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 5-3t , -,4 SVCS r/ ,\l IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) SITE WORK FOR PROJECT TYPE: IAS//FR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? El E YES, FROM VA C !'l r"�6`e, A TO �17U L-I lf� yo`Ly NEW WATER/SEWER SERVICE NEEDED? I�L NO ❑YES,TYPE SIZE SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: ❑ FENCE IN ROW FT IN HEIGHT RIVEWAY APRON/CURB CUT �� FT WIDE 171 ASPHALT/CONCRETE PAVING �7 Z 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 r CONTACT INFORMATION Kc-it OWNER NAME: (v inJ OWNER MAILING ADDRESS: STREET 3 ( I-�G Y E-�Lj^ Y`�t- �v�{�� /n� n CITY E STATE r) zip OWNER PHONE: I �� 37 I OWNER EMAIL: APPLICANT NAME: APPLICANT MAILING ADDRESS: STREET I V r4 57- qQ- "La 3 7 CITY STATE ZIP APPLICANT PHONE: t+'I 3S APPLICANT EMAIL: �� i PRIMARY CONTACT: OWNER APPLICANT EVOTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 3 41�1CONTACT EMAIL: ACKNOWLEDGEMENT.'I ha e reviewed this application and confirm the information contained herein is true and correct. Work done rsuant 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.1 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 �-..)Authorized Agent Signature Date (Revised 10/12/2015)