2102 SUMMIT AVE 2018-02-09 - Laserfiche WebLink

OLT KWIC WORKS PERMIT P'LICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits / PROJECT SITE INFORMATION PROJECT ADDRESS: /O 2— s-thmmr'1" aft ( NTS A- I IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) SITE WORK FOR PROJECT TYPE:USER-DETACHED USER-ATTACHED DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? ❑ NO 01 YES, FROM Amod {'1S/c�1 C.i TO w1/4X NEW WATER/SEWER SERVICE NEEDED? ❑ NO )I YES,TYPE SIZE SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: 4AX .Sie W c' ❑ 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 6CONTACT INFORMATION OWNER NAME: eicA A/9,41 eS ,LCL OWNER MAILING ADDRESS: STREET (74 z0 3/5-1- ,qvj, frG CITY Z—V..er-t.r f STATE [4/71 ZIP 9g,�y OWNER PHONE: IC ?'7c //i3 0 OWNER EMAIL: 66 t cavil cv?l, /1/Q1- APPLICANT NAME: „ -c,•,2/4-1I y4 / á/ APPLICANT MAILING ADDRESS: STREET gs'Zo _:iv?t 1 Ye CITY ,G vl t`L/f STATE ��y� / ZIP `jg'Z APPLICANT PHONE: 12'S 'j 6 7/JO APPLICANT EMAIL: 60,-(166,�(c.jAc�j5 7,,4/c� PRIMARY CONTACT: AI OWNER /'s APPLICANT ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: Z5- f77 7/y0 44;74/ 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 1 comply with the State Contractors Law 18.27 ROW and 296.200A WAC. City of Everett Official Use Only PERMIT# / z../zzh 5 PW 1511--n\ Owner/Authorized Agent Signature Date (Revised 10/12/2015)