600 10TH ST 2017-09-25 - Laserfiche WebLink

PIOLIC WORKS PERMIT PLICATION CITY OF EVERETT PERMIT SERVICES 04= 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: &CO 100 Sit 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? ,Er NO ❑ YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? NO ❑ YES,TYPE SIZE SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: cc l sad ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON /CURB CUT FT WIDE �(`5y� rift/L ASPHALT/CONCRETE PAVING /,�ZZ SF ( _ n _IA"VS1v1 ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LFV rl� �� ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT t ` � SCJtzt ❑ CLEARING/GRADING/FILL/EXCAVATE CY o-v'z& ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION OWNER NAME: rf OWNER MAILING ADDRESS: STREET 6r6:t%ffL _,4 n CITY Cif STArE L(. i ZIP OWNER PHONE: OWNER EMAIL: APPLICANT NAME: 66::2 RG>DlXI hA APPLICANT MAILING ADDRESS: STREET 12-657 CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: b h,l -t&f_,r r Cpyyt PRIMARY CONTACT: ❑ OWNER aAPPLICANT ❑ OTHER (Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: �ZS_3�$-UCo l3 i5rQ-�� CONTACT EMAIL: w1�u' cel' a ev .C�+v1 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. 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# Owner/Authorized Agent Signature Date (Revised 1 0/1 212 0 1 5)