2401 BROADWAY 2017-10-17 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION .: PROJECT ADDRESS: aLA o Z �t('t U,►A� 'i t't`�t'I I'L) ID IF APPLICABLE: ❑LAND USE PROJECT#(SEPA,PRE-APP,SS,ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY QCOMMERCIAL ❑INDUSTRIAL CHANGE OF USE? t4NO ❑YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? fR-NO ❑YES,TYPE SIZE i SITE WORK%RIGHT-OF-WAY APPLICATION-INFORMATION+ DESCRIPTION OF WORK: sv)a l�� J, �cwl (11() i✓t -}k3 Gj t �' C."U�'r e1'-;-,14+ a�. t/�Y" LAS 14)= r� t�,i�2( U�`�Vi 1^�_ P.( ' 4111 46 c(c>tc jZt 6 tc 4l,) M/,1 lel (()A) T 0146 kir S IFcJAk1I'A ❑FENCE IN ROW FT INH EIGHT ❑DRIVEWAY APRON/CURB CUT FT WIDE I r ❑ASPHALT/CONCRETE PAVING SF ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑RETAINING WALL i ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑CLEARING/GRADING/FILL/EXCAVATE CY ❑CUTI OR IN PAVEMENT(PARALLEL) '6 `A I f <_-vl, J 00(72 415 ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF I i i CONTACT-INFORMATIQN OWNER NAME: M(?,. OWNER MAILING ADDRESS: sT.EET �' Z [�.^j Crit ;El{(.�, r STATE LAJ OWNER PHONE: u 0 (.7 rl — '� OWNER EMAIL: (�PJ ti�^� J✓1. ('0. A APPLICANT NAME: APPLICANT MAILING ADDRESS: sTREEr R 1`ab . ;,Aj PA`' r CTTY 61 ;;I G 4� STATE V A J� A APPLICANT PHONE: V_. S JAPPLICANT EMAIL: R o' EPT ' i?Mi PRIMARY CONTACT: ❑OWNER -APPLICANT ❑OTHER(Architect,Engineer,Etc.) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: ACKNOWLEDGEMENT.,1 have reviewed this application and confirm the information contained heneff 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 l am authorized by the owner of this property to perf—the wnrk fnr which annlication is made.and i comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Oficial Use Only PERMIT# 7/6/2016 PW l6 & O• Date (Revised 10/12/2015) 1