Laserfiche WebLink
P 1 I LIC WORKS PERMIT Am=LICATION <br /> '411 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 I (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2 6O ' k1 R-- UR-- <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:DSFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX DMULTI-FAMILY El COMMERCIAL DI INDUSTRIAL <br /> CHANGE OF USE? 'NO D YES, FROM TO _ <br /> NEW WATER/SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE <br /> SITE WORK,'I RIGHT OFA:WAY APPLIcA I[ON 1NFORMATLON., o �,�/� <br /> DESCRIPTION OF WORK: vW0d f"I/i' , 1041k)6".01(' <br /> i `"�' c"""(A•�(/ice (Ai \Vim' ` ' 0-1 i+- <br /> FENCE IN ROW FT IN HEIGHT <br /> D DRIVEWAY APRON/CURB CUT FT WIDE <br /> 0 ASPHALT/CONCRETE PAVING SF E(c: <br /> l YEIr <br /> rZ <br /> D RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF11) <br /> D RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT c ` MAY - 8 2018 I <br /> D CLEARING/GRADING/FILL/EXCAVATE CY C ni OF EVERETT <br /> D CUT/BORE IN PAVEMENT(PARALLEL) LF Permit : >?r:,/ices <br /> 0 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT.INFORMATION _ <br /> OWNER NAME: IkL(/) ,t, <br /> OWNER MAILING ADDRESS: STREET Roti pa01v1�tN Ave <br /> • <br /> CITY iAJeAJIA-1 STATE�{�' � UjO ZIP q I <br /> OWNER PHONE: 0 n 0 OWNER EMAIL: je mkti.60 I b')4--1I Cil <br /> ` <br /> APPLICANT NAME: rY\LOLia. <br /> n / 1y yl� / <br /> APPLICANT MAILING ADDRESS: STREET &W ir v`� a1`� wb"'t <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: 1 OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> ACKNOWLEDGEMENT:I 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 /> / 4110 <br /> Owner/Authori -d •.entSignature ►)ate (Revised 10/12/2015) <br />