25 74TH ST SW 2017-10-26 - Laserfiche WebLink

PIOLIC WORKS PERMIT PO '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: 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: 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' 4` GX4__R 0`V CR`Tf- I I EPG11FT 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: ,�,` 1 r ✓4 OWNER MAILING ADDRESS: STREET -74� r4' CITY STATE ZIP OWNER PHONE ci OWNER EMAIL: APPLICANT NAME: APPLICANT MAILING ADDRESS: STREET Cry STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: LISO, WNER ❑APPLICANT ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 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 permi nl authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the Building Official before being authorize nd any circumstance.l am the owner,or I am authorized by the owner of this property to pe m the work for which a lication is made,and 1 comply " t e S e Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# p W 160 S - 057 Owner/Authorized Agent Signature Date (Revised 10/12/2015)