25 104TH ST SE 2018-03-29 - Laserfiche WebLink

4.- PLIC WORKS PERMIT _ PLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 i FAX 425-257-8857 1 (E) everetteps@everettwa.gov ( www.everettwa.gov/permits _. a tPROJECT SITE INFORMATION_ PROJECT ADDRESS: ZS (COI+1-1 ST S. E. (G(?( p rr 00 396cl 0000 loo) IF APPLICABLE: LAND USE PROJECT#(SEPA, PRE APP,SS, ETC.) SS I dn-©O I SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED El SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMM ERCIAL ❑INDUSTRIAL CHANGE OF USE? 0 NO 0 YES, FROM TO G( NEW WATER/SEWER SERVICE NEEDED?) 0 NO ®'YES TYPE S SIZE Ut c/1 Mstidu a ur Sse. urtttA is-07- n/9 OW) SITE WORK RIGHT OF WAY APOLICATIONI;NFORIVIATIO,N DESCRIPTION OF WORK: By •k d i n S A kn s.c. -I- as_s ,`, sKy_ Work . o FENCE IN ROW FT IN HEIGHT ErC70117F1' ❑DRIVEWAY APRON/CURB CUT FT WIDE D I I I ❑ASPHALT/CONCRETE PAVING SF JUL2 201S ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT CITY OF EVERETT o CLEARING/GRADING I FILL!EXCAVATE CY Perrnit Services ❑CUT/BORE IN PAVEMENT(PARALLEL) LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION OWNER NAME: ,30,k e,S k)e,co", .. OWNER MAILING ADDRESS: STREET 10 1\3 Lew;Cir, -Av.t- 5 y r CITY E,....2_r4_4(--- STATE W 4 ZIP ,�/ZG OWNER PHONE:( 7 ,VS 413) �(�--��7 S OWNER EMAIL: Go�'�U o oL+ac+•cow APPLICANT NAME: j.N.e-e- APPLICANT MAILING ADDRESS: STREET CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY'CONTACT: gOWNER' 0 APPLICANT 0 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 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# "' 6 '7/2(2/Io PW/6°7 — ° o Owner/ ut ; ized .gent Signature Date (Revised 10/12/2015)