209 112TH ST SE 2019-01-30 - Laserfiche WebLink

"111°'/NA1,--":4 PE LIC WORKS PERMIT PLICATION 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: q I I 6+ 5E E✓t -c tt Ao ' IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX El MULTI-FAMILY ❑COMMERCIAL CI INDUSTRIAL CHANGE OF USE? 0 NO 0 YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE SITE WORK/ RIGHT-OF-WAY APPLICATION-INFORMATION j DESCRIPTION OF WORK: C r-LCA ,-C O e,OAc,i21 pat 1 i4S vl�. iNor-t`\ s I o o OtAS-c,_ / 9C / .' and Q a{T /'7 X ;66 r o FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE .ASPHALT/CONCRETE PAVING 47 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 ^.� CONTACT INFORMATION i OWNER NAME: 5 ( 4Ca h c-Jsf, Poe I z-tr- OWNER MAILING ADDRESS: STREET ,�A,0� �,.:L .3-6- S L' • CITY /W 7r STATE v/A"/ ZIP 9 k OWNER PHONE s Sq 7d,'fib O OWNER EMAIL: Prize CsOMC, er.Aef APPLICANT NAME: APPLICANT MAILING ADDRESS: STREET 50 �o V_g CIN CA � STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: gOWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: Yr/ 0Q., f 1'Q+k.„r CONTACT PHONE:CL// ,0 V7 '9_00 Get(:„to ra 9so 322 CONTACT EMAIL: -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# 2/7 i PW 180o - 0624 Owner/A t orized Agent Signature Dat (Revised 10/12/2015)