Laserfiche WebLink
PIELIC WORKS PERMIT I$PLICATION <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 I www.everettwa.gov/permits <br />'= PROJECT=SITE INFORMATION �'�� <br />PROJECT ADDRESS: j <br />IF APPLICABLE: ❑ LAND USE PROJECT# (SEPA, PRE-APP, SS, ETC.) <br />SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI -FAMILY <br />❑COMMERCIAL 19NDUSTRIAL <br />CHANGE OF USE? �NO ❑ YES, FROM TO <br />NEW WATER / SEWER SERVICE NEEDED? NO ❑ YES, TYPE <br />SIZE <br />R N M R <br />` 4s-S'ITEUVO Ka% IGHT OF=WAYAPPL ICATIO" NFORA�TION "' ' ' <br />�fi%'s <br />�• c_ ..�...,.. .r. , , _ ?..�, <br />�� <br />as.z. >�•`.x,. .t. �,^€vsa:;ts:,v.. e { <br />DESCRIPTION OF WORK: �j 1 "� <br />i <br />❑ FENCE IN ROW <br />FT IN HEIGHT <br />❑ DRIVEWAY APRON / CURB CUT <br />FT WIDE <br />❑ ASPHALT / CONCRETE PAVING <br />SF <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY <br />LF <br />❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT <br />FT TOTAL HEIGHT <br />❑ CLEARING / GRADING / FILL / EXCAVATE <br />CY <br />❑ CUT/BORE IN PAVEMENT (PARALLEL) <br />LF <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) <br />LF <br />CONTACT INFORMATION <br />OWNER NAME: <br />OWNER MAILING ADDRESS: <br />STREET <br />CITY <br />STATE ZIP <br />OWNER PHONE: Z`j <br />OWNER EMAIL: <br />GQ �C�C5z1/1� <br />APPLICANT NAME:` <br />SQ <br />APPLICANT MAILING ADDRESS: <br />STREET I'D <br />CITY <br />STATE ZIP <br />APPLICANT PHONE: <br />6-?qZ <br />JAPPLICANT EMAIL: <br />Q MA S-V1. <br />PRIMARY CONTACT: ❑ OWNER WPPLICANT <br />❑ OTHE rchitect, E <br />bineer, Etc.) <br />CONTACT NAME: <br />CONTACT PHONE: <br />?4 '� <br />6-7 qZ <br />+ l <br />N>✓-LC7D�'V <br />CONTACT EMAIL: <br />yje CV) ,4C-01-A <br />ACKNOWLEDGEMENT. I have reviewed this application and confirm the information contained herein is true and correct. work done pursuant to tnis 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 />pW161�_Ozld <br />(Revised 1011212015) <br />