1710 BAILEY AVE 2019-01-17 - Laserfiche WebLink

PLWIC WORKS PERMIT LI TINS 1�►' 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: /7/0 //Q/ //dL_. IF APPLICABLE: 0 LAND USE PROJECT/#(SEPA, PRE-APP, SS, ETC.) SITE WORK FOR PROJECT TYPE:jTSFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? !4'NO ❑YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? KNO 0 YES,TYPE . SIZE SITE WORK,/ RIGHT OF=WAY APPLICATION INFORMATION „ DESCRIPTION OF WORK: C'4an9.e_ 5/4re 4 a S/ir7e-is)rrrpte drIve_a cy '-oma., dra/heA0(2- a wily 1r11m. c j - d0c.90r, t/ ❑ FENCE IN ROW FT IN HEIGHT ISI DRIVEWAY APRON/CURB CUT /12 FT WIDE ❑ASPHALT/CONCRETE PAVING SF ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF D ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEI ❑CLEARING/GRADING/FILL/EXCAVATE CY APj '6 2018 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF #X T'" r" ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF � 'rrrpi f 7 CONTACT INFORMATION OWNER NAME: ,4/�n >_ OWNER MAILING ADDRESS: STREET -2-0 2-Z WQ lch Ad /y crrY noham/s A STATE 40,4 ZIP q8:q$ OWNER PHONE: 425 - ?iZ3— lo®/7 OWNER EMAIL k i/ ✓ Q k) Al- 13 riPa`m G�JY�7 APPLICANT NAME: 4 U/ /42— APPLICANT 2— APPLICANT MAILING ADDRESS: STREET 2_25- Welch /?4' CTY ..5;;Ohoi- A STATE ZIP QLQ p/ APPLICANT PHONE: 4257- (.„9/7' APPLICANT EMAIL: 5/ �Q e4 4-Oh /eI"rG �a tt PRIMARY CONTACT: TOWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 9,?3— /7 ,4/4/,7 /4i/e - CONTACT EMAIL: At/ , alj J-t��1 / /corn ACKNOWLEDGEMENT:1 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 lam 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 PW 0.) t �� Z Owner/Authorized Agent Signat re Date (Revised 10/12/2015)