Laserfiche WebLink
PU JC COS PE ; IT UCAT ®N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ),7 a - c 4 <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED IteDUPLEX ID MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE:? I$NO 0 YES, FROM TO - <br /> NEW WATER!SEWER SERVICE NEEDED? 1I NO 0 YES,TYPE SIZE <br /> .SITE WORK'/ RIGI-iT-OFWAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: �� 1/ <-1(c5r- f G; <br /> M*Je- 1' -r° aer.44- TV k-iq,v' w I �DwEs� Po tz <br /> 7kFENCE IN ROW FT IN HEIGHT <br /> © DRIVEWAY APRON/CURB CUT FT WIDE <br /> ❑ASPHALT/CONCRETE PAVING SF 8 2017 <br /> CIRETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF I� :', DEC ' <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT c `''y OF EVER E <br /> o CLEARING/GRADING I FILL!EXCAVATE CY Permit ' <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: (10 gj L L C-- <br /> OWNER <br /> OWNER MAILING ADDRESS: STREET c/ G -- D c%AJ A it& kE <br /> CrrY STATE V.-4w- ZIP <br /> OWNER PHONE: 40' 949 i v 5 e OWNER EMAIL: uK 1401Ca . "t°c{'.' l* <br /> APPLICANT NAME: 4,-f&ka <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: v ...�. ,_� ...APPLICANT EMAIL:-,...Ww_ .. u .. x .., m�.m _ w._..� .�. w <br /> PRIMARY CONTACT: ig OWNER 0 APPLICANT 0 OTHER(Architect, Engineer,Etc.) <br /> CONTACT NAME: CONTACT PHONE: lP 4941" 1r"5 <br /> �v k-40,4 t-torcr, CONTACT EMAIL: <br /> ACKNOWLEDGEMENT:1 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.I am the owner,or I am authorized by the owner of this property to <br /> perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ttjl ,/ r1 low1 12 32 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />