Laserfiche WebLink
ell .-1 UbLIc WORKS PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I https://everettwa.gov/permits <br /> PROJECT SITE(/ INFORMATION <br /> PROJECT ADDRESS: z 5'62 Lit C, Ltd 14 v --' <br /> SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL El INDUSTRIAL <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) <br /> IF APPLICABLE: 0 FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# <br /> UTILITY COMPANY'S NAME&JOB#: JOB# <br /> DESCRIPTION OF SITE WORK/RIGHT-OF-WAY WORK <br /> FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: <br /> I2 FENCE IN ROW 6, FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> ❑ASPHALT/CONCRETE PAVING SF <br /> ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> ❑CLEARING/GRADING/FILL/EXCAVATE CY <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> ❑POLE WORK/AERIAL/OVERLASH LF <br /> ADDITIONAL DESCRIPTION(AS NEEDED): <br /> CONTACT INFORMATION <br /> OWNER/APPLICANT NAME: _S-k p lit M/e. g � / VX {� <br /> OWNER/APP. MAILING ADDRESS: STREET 7 _ 'H r 5 Li 4A1, P.C (/R__ / <br /> WCITY 5 �J <br /> /rt_i STATE 104 ZIP q5�V <br /> OWNER/APP. PHONE: 1"/Z.. 3,"�. 3 S-2-3 OWNER/APP.EMAIL: 5-1-ef AGt,,A,dpit- ci-jq,U)o(a, q�y>� -- <br /> CONTRACTOR NAME: / <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#( QUIRED): EVERETT BUSINESS LICENSE#(F EQUIRED): <br /> PRIMARY CONTACT: VI4 OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE:Z/2 . Z/ , 35-Z—J <br /> 5 1 /Q. p. (tir-&UX CONTACT EMAIL: c 4.._ � - w k � ,4 r 4 cza,-) <br /> ACKNO EDGEMENT.:I have reviewed this application and confirm the information contained he in is true and correct. Work done pur ant to this permit must <br /> 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 <br /> authorized in writing from the Building Official before being authorized under any circumstance.lam the owner,or lam authorized by the owner of this property to <br /> perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ,,,,,/, - //4., PW1gii-o,0 <br /> O ner/Authorized Agent Signature )y6Ii7 <br /> e (Revised 1/52017) <br />