10012 1ST DR SE CHASE BANK 2019-05-02

PIOLIC WORKS PERMIT PWLICATION 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: Qp IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY PqCOMMERCIAL ❑INDUSTRIAL CHANGE OF USE? NO ❑ YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? 19 NO ❑YES,TYPE SIZE SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: ® INS ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE 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 CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: STREET _Fb 1 p J �t CITY 11iJ 1 STATE QA ziP OWNER PHONE: C/Q �r] j7 OWNER EMAIL: N� APPLICANT NAME: APPLICANT MAILING ADDRESS: STREET 1-0 Aa O CITY STATE LA ZIP APPLICANT PHONE: '�� 9 JAPPLICANT EMAIL: JULA I,, G(ZO L ._ PRIMARY CONTACT: ❑ OWNER APPLICANT ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 5 u 0 r CONTACT EMAIL: 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 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# PW II _/0 !-L Owner/Authorized Agent Signature Date (Revised 10/12/2015)