11130 3RD PL SE 2019-05-23 - Laserfiche WebLink

"111111AY—r—A PLIULIC WORKS PERMIT ArPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 (E) everetteps©everettwa.gov I www.everettwa.gov/permits -PROJECT SITE INFORMATION PROJECT ADDRESS: Iv V ,I" c6 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: ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE 'VIASPHALT/CONCRETE PAVING L,7SSF ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF07:;:d ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGma 2 7NIB D CLEARING/GRADING/FILL/EXCAVATE CY ❑CUT/BORE IN PAVEMENT(PARALLEL) LF CITY OF EVER. ETT ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Pit mit efV%Ce CONTACT INFORMATION OWNER NAME: CA/VT+cS�I(,Liv Geo 1T1JrA-c 1J OWNER MAILING ADDRESS: STREET //I I i Z ) A' L x Share- /j/Z CITY C S ' "'V V iA/S STATE lti'� F�,, ZIP 9(2 5/9 OWNER PHONE: 2S S. .. S a). NER EMAIL ( i G.... rckf2 r5 . . �/ 4.'' con/ ../_ .,...M.,, .,W,.K,..,..�,..�M.,........MM APPLICANT NAME: C h Y 1 S � w Co ro!'vr�cl°/ co APPLICANT MAILING ADDRESS: STREET CITY STATE ZIP APPLICANT PHONE: APPLICANT EMAIL: .�..,.�.�..n..._,,,,..,..,NMa,,. 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.I am 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# 63 /24 Jig Pwl6os -067- Owner/Aut' .rized Ag tSignature Date (Revised 10/12/2015)