2119 E GRAND AVE 2018-01-04 - Laserfiche WebLink

� . PUL�LiC WORKS PERMIT APPLICATION � CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: Z,� � _ . .�� (� .. �.+ � -,� i' : ::_� , IF APPLICABLE: ❑ I_/�ND USE f'ROJECT#(St_f'F1, f'RF-nPf', SS, ETC.). SITE WORK FOR PROJECTTYPE:❑SFR-f)(,TACIiF:D ❑Sf R-AT I'ACfII D ❑f)UPLf.X ❑MUI.TI-FAMII.Y ❑COMMF:RCIFIL ❑INUUSTRI/�I. CHANGE OF USE? L�NO ❑YES, FI�OM. _ _ _ �U NEW WATER/SEWER SERVICE NEEDED? I�1 NO ❑ YES,TYPF SIZF SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: p r ( �� .c� ( ❑ FENCE IN ROW F=T IN HEIGHI ❑ DRIVEWnY APRON/CURE3 CU l F=1-WIDE ❑nSPHALT/CONCf�FTF PAVING S� ❑ Rf=TAINING WAI_I /ROCKERY IN KIGHT-OF-WAY I.F ❑ RFTAINING WAL.I_/ROCKFRY OVF_R 4FT IN HEIG�17:—___` FT TOT/\L HEIGHT �- , � �CLE/�RING/GRAI�ING/FILL /1-X�AVl�7� ' '� � � � CY � ❑ CUT/BOKF_ IN PAVEMkNI(I'ARALLkL) �� LF- ❑CUT/BORE IN PAVF_MENT(NON-P/�f2l�LLEL) LF CONTACT INFORMATION OWNER NAME:.��'�,..�,,. Cr ��,�� ; . _ �\. �� ' - OWNER MAILING A[�DRESS: sTr�t-r-T '� \l� � (-��- , �� � . ciiv -�� ' l�� sinit l'v/�� iir� C�� , � OWNER PHONE �:-}S '; �;��, - �\�-��`, OWNER EMAIL: �v��` ;'(, �� .-.t-:��I /-- APPLICANT NAME: \ �h � - �� APPLICANT MAILING ADDRESS: srrzrFT , \�G — C-.,��.,-� �, ;�� • �nv � _� , .��-�- srnTe l,.i rF iiF> �I-� r C''� APPLICANT PHONE: =`j;> �` � . �,". APPLICANT EMAIL: �v'.�'�c��C_-�„ (:,�`v}I L- � �`.� PRIMARY CONTACT: ❑OWNFR ❑APPI ICnNT ❑OiHFFt(Architect, F:ngineer, Ftc.) __ _ _ _.___ CONTACT NAME: CONTACT PHONE: � _ '� „ ,` ;-t� �,t��.��--�1 ��,- `� �.{ i h_, ��,\ _ _ ;� CONTACT EMAIL: ,�1:`�.:� ,i� �, �. a�r�\� . r; ; /ICKNOWI I:OGF Mf M:I havc reviewed this application and confirm the info�mation contained herein is true and correct. Work done pursuant to this permit must cornply with current federal,state.and local law. 7he granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing irom the f3uilding OKicial before being authorized under any ciraimstance. 1 am The owner,or I am authori�ed by fhe owner of this property ro perlorrn thr,work for which application is rnada and 1 cnmply with the State Contractors l.�w 18.27 RCW and 996.200�1 W/1 C. City of hvcrett ONicial Use Onl}� PI.RMfT # ' � PW ' �0 � ..,I�� -- ��- t-,�. Owncr/Authori ed Agent Signature Uate (Izcvised 9/23/7016)