Laserfiche WebLink
PALIC WORKS PERMIT AORbLICATION <br /> 1.11111 -- <br /> 41 1CITY OF EVERETT PERMIT SERVICES <br /> M�� 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov www.everettwa,gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 31( a 5'4k 54 ( up.fr-f 1 WA q3-0)0( <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPESFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX DMULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? 0 NO 0 YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE <br /> SITE WORK! RIGHT OF=WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: 4:04 C <br /> Lv� FENCE IN ROW FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> IECEOVED <br /> ❑ASPHALT/CONCRETE PAVING SF <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF JUN 0 6 2017 <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT CITY OF EVERETT <br /> ❑ CLEARING/GRADING/FILL/EXCAVATE CY Permit Services <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: Apr( ( c 1(frr? <br /> OWNER MAILING. ADDRESS: STREET 31(0 (354k 54 (ALA" <br /> J� <br /> CITY (ler?if STATE W J A}t ZIP giJp l// <br /> OWNER PHONE — OWNER EMAIL t yN, -f }(-'(4/,I u utt a <br /> PHONE:__ � �,.. .,.w�.� _........w �....�.,.�R �.,,M... .,� �.�.,.�.... ,�. . n._...�.... .._M...�. .n.., �...�.w..�u....w.._..�.r. <br /> APPLICANT NAME: <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: 0 OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must <br /> 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 <br /> authorized in writing from the Building Official before being authorized under any circumstance.lam the owner,or tam authorized by the owner of this property to <br /> perform the work for which application is made,and t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> r � G /.4,PW r' �- o � <br /> C � <br /> Owner/authorized Agent Signature D to (Revised 90/92/2095) <br />