4501 RUCKER AVE 2019-04-17 - Laserfiche WebLink

LIC ORKS PE 1 i _,11T -"Lid/ TION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E) everefteps@everettwa.gov I www.evereftwa.gov/permits ry PROJECT SITE INFORMATION` PROJECT ADDRESS: --f \ �u �C I ,V v 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/SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE SITE WORK'/ RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: GING SatuLsS cex—6urN( 0 FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE LF❑ASPHALT/CONCRETE PAVING SF iEcE-vE-1 ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY OCT 3 0 2017 -/ ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑ CLEARING/GRADING/FILL/EXCAVATE CY CITY OF EVERETT Public Works - Permitting ❑CUT/BORE IN PAVEMENT(PARALLEL) LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: STREET - ,t+G%t1�S j� Z�' C� (�a/\ CITY i \ A ce _- STATE wZIP \C:v \ OWNER PHONE: OWNER EMAIL: APPLICANT NAME: APPLICANT MAILING RESS: STREET CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: OWNER 0 APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: -3 .03 a-Z C� 0-0,��, j. CONTACT EMAIL: C . - --- ACKNOWLEDGEMENT:I have nevi this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with current federal,state,an ocal 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 am authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 ROW and 296.200A WAG. City of Everett Official Use Only PERMIT# O SO PW / 7/O - d 3 Owner *'" Ize- •.en Signature Date (Revised 10/12/2015)