11316 2ND AVE SE 2019-05-23 - Laserfiche WebLink

'IP"• P SLIC WORKS PERMIT4PLICATION5`111CITY OF EVERETT PERMIT SERVICES3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwagov I www.everettwa.gov/permits R � SI .. :.. rt PROJECT ADDRESS: i 3 /b K<Q Ave S (- uQ i(`r..< 207. 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 0 YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? IR NO ❑YES,TYPE • SIZE _ :+sno+.� � v �� , SIaTE WORK RHTOWAYA�PLI�TION N ORMA,TONS° Nw DESCRIPTION OF WORK: A C 4,'r CLOC ,r ' Lt,✓1 7 ❑FENCE IN ROW FT IN HEIGHT JEL DRIVEWAY APRON CURB CUT FT WIDE ❑ASPHALT/CONCRETE PA ING 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 „. &O OWNER NAME: \ (•/ 4 t t 5 t . I `-1-‘) OWNER MAILING ADDRESS: STREET t l ( ( 3 S I S CITY CJ QJi/`Q STATE L.L4/ ZIP Pe ?G F OWNER PHONE: (( - 3 yL a - OWNER EMAIL: U Ct vt vs;ct t- Fro /7 DLA <c ? ( a v APPLICANT NAME: t�. V&i 4,-.\ uL APPLICANT MAILING ADDRESS: STREET ( ( C ( (3 r S 1 s / CITY I r (”R/1/e STATE (i(✓ ziP 9c/- c APPLICANT PHONE 14'2 - 31i-cc a2o -3` APPLICANT EMAIL: V c 'Ina L.t,`x-o yy't Gum.r �' z_ � K, PRIMARY CONTACT: E("OWNER ❑APPLICANT 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: Ll L `j g,4 -2 a `�k to a y\ VS 1,1 47 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# (-? l /1Owner ArizedPW Agent Signature Date (Revised 10/12/2015)