3412 BELL AVE 2019-01-17 - Laserfiche WebLink

PL_WIC WORKS PERMIT ,APPLICATION h CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT ADDRESS: j a. 13e 1I RV / E ver _// 1Viq qgpo IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS,ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 0 NO 0 YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? 0 NO ❑:YES,TYPE SIZE B _ <uk.�.<....kgfe �� KRrG ��HTO -k, evegA7OFOIR t�I .E 21: DESCRIPTION OF WORK: ;i> c`1 ve jj& i PIc y) )aci'fa a s (S ,app K • // / 7 3 g, ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT . FT WIDE lC)f �01 apprc v SPHALT ONCRETE AVING Lt/ / 17 SF ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑CLEARING/GRADING/FILL/EXCAVATE CY ❑CUT/BORE IN PAVEMENT(PARALLEL) LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF OWNER NAME: 3 e4,r) OWNER MAILING ADDRESS: STREET 3�j_1f/a �- J/ /We_ CITY ejr-ere-// STATE ZIP 92-i) p./ OWNER PHONE: OWNER EMAIL: �1 APPLICANT NAME: 4 L.1- C et iv APPLICANT MAILING ADDRESS: STREET 2 CITY ,C�JOfi-t lf STATE 1.1-14 ZIP 9 s-Zz) 1 APPLICANT PHONE: 1�,5 Qj 2 5 9'9 // 'APPLICANT EMAIL: / R�`/r rt/1 71/-0/1//-1 -71)4 //, CGlvl �,...m�.=�.��,...._v,�. PRIMARY CONTACT: 0 OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME:` Cyy� CONTACT PHONE: e-47 5-3 a g-'-] 5r o� / Hot/ L . / k O/2f CONTACT EMAIL: kar-/ , nn @,n 7-►' nii er/na//,COm ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true ahtl correct Work dene 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 1 comply with the State Contractors Law 98.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# PE / 1 VV '809- oz0 Owner uthorized Agent Signature Date (Revised 10/12/2015)