8728 9TH AVE SE 2019-05-23 - Laserfiche WebLink

477U LIC WORKS PERMIT APPLICATION 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 https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: qiq 'v" Aoe SE EVte.'c.-W 'W 1.1-70q. SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED DSFR-ATTACHED ❑DUPLEX DMULTI-FAMILY DCOMMERCIAL El INDUSTRIAL IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) IF APPLICABLE: 0 FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# DESCRIPTION OF SITE WORK/ RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: ❑FENCE IN ROW FT IN HEIGHT ❑DRIVEWAY APRON/CURB CUT FT WIDE 'ASPHALT/CONCRETE PAVING r.3q SF 0 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 ❑POLE WORK/AERIAL/OVERLASH LF ADDITIONAL DESCRIPTION(AS NEEDED): CONTACT INFORMATION OWNER/APPLICANT NAME: (\A tn; Jul OWNER/APP. MAILING ADDRESS: STREET $17 I? 7f" 14Va. 5E CITY \Jeet- STATE V' It) ZIP 97zos- OWNER/APP.PHONE: -)25- ScC'30455- OWNER/APP.EMAIL: f e'i'e-r-. VIA 3 7 C9 y ct 1-•00 ,C p Iy/ CONTRACTOR NAME: rjc,,,,,.1.e p S a,j96 -e d CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): I EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ErOWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: (,i c_3 - 3 q S S (M ; \, i- CONTACT EMAIL: Pd e r v v 31- a 0,1.00,C o Pvi ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Wolf 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# ` C9 15 V pW /610 - d3? Owner/Authorized Agent Signature Date (Revised 1/52017)