1321 KOSSUTH AVE 2019-02-11 - Laserfiche WebLink

#1/11/PAh,,,,,..._A Ply LILIC WORKS PERMIT LaI TIO N 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; 1 32. ( V---p 5S l/`Cl k. A Lie , 5,ver 1 3 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 ❑INDUSTRIAL CHANGE OF USE? ❑ NO ❑YES, FROM TO NEW WATER!SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE SITE WORK I RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: e -1," 5 4g/I !tti J ' P;11& re rr - 'o l` 'a itfS 5ratAL r( di-IL MI �rd G 4 •- ni;f- ' ii/ I1 S a pa w ' adz ❑ FENCE IN ROW FT IN HEIGHT • DRIVEWAY APRON/CURB CUT FT WIDE ❑ASPHALT/CONCRETE PAVING SF ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT 0 CLEARING/GRADING/FILL/EXCAVATE CY ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION OWNER NAME: ',-t\-- (.C/ OWNER MAILING ADDRESS: STREET l 3V.--06044-1,, V/4 .6...ye/4i_ p / - l /' 4 CITY / STATE (��1 J I F{ ZIP 3 OWNER PHONE:P. G 6 3 Q c3 OWNER EMAIL ‹e166iv f fG �G9 C ;�' Ld1"'‘ APPLICANT NAME: G��J APPLICANT MAILING ADDRESS: STREET CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: [OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: ACKNOWLEDGEMENT:I 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.lam the owner,or I am 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# — 12,-- f PW 1 & 7 - 1Z-''?. ,,,,, (At(' Owner/Authorized Agentrgnature Date (Revised 10/12/2015)