4012 HIGH ST 2019-03-27 - Laserfiche WebLink

PALIC WORKS PERMIT I.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: I-16 / Z 1-(/J ej k S- -{', �I-L�r4 . �j 2-0 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? ❑NO ❑YES, FROM TO NEW WATER 1 SEWER SERVICE NEEDED? ❑ NO 0 YES,TYPE SIZE SITE WORK/ RIGHT OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: (kyCSU`-Itld t-cfC on, 1 (ft 4(OA U-c- Q,C read 10 fa_c.,e__ 0 FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ASPHALT/CONCRETE PAVING SF L '1 0 RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF JUN 19 2018 iti o RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT C I y Q , �I T - ❑CLEARING/GRADING/FILL/EXCAVATE CY Fie rm i t s •{•�/•^-%i ❑CUT/BORE IN PAVEMENT(PARALLEL) LF 0 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION OWNER NAME:-- 6( -4- OC (`o�\�• .r OWNER MAILING ADDRESS: STREET 116)' ( D+ h CITY j V •Q STATE �- ZIP 2-V OWNER PHON Z ( `40 l 72 �rJ '10b � uls lu'/y�/ ! . corn 1OWNER EMAIL Q .....,.�.,........�,,...._..,.w...�,_�...,�...,..��. ..�,,.�,w_ _.,.k�...,,M... ...�,...., ...,.....wGG APPLICANT NAME: 5&fr v,p ex--5 Ot--40(e 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. Workdone 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 1 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# 03 2- • 0 ft PW I GeD 6,-' •3; Owner/Authorized Agent Signature Date (Revised 10/12/2015)