4002 NASSAU PL 2019-06-05 - Laserfiche WebLink

BLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 471Err (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov l https://everettwa.gov/permits PROJECT SITErINFORMATION PROJECT ADDRESS: 4002 IpC�ls,c-,,, `lam\ 1 vv e ce \,k. 0%-201 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑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 APPLIC BLE: I FENCE IN ROW 42, h S FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑'ASPHALT/CONCRETE PAVING SF VI'RETAINING WALL/ROCKERY IN RIGHT-OF-WAY ap LF ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT ' �d7 / FT TOTALHEIcF�T� L.,,�f� , ��,',"�1` ,;h ° 1)7) 0 CLEARING/GRADING/FILL/EXCAVATE CY NOV ..a t II ❑CUT/BORE IN PAVEMENT(PARALLEL) LF NOif 2 9 2018 ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF C I Ty o f o POLE WORK/AERIAL/OVERLASH LF PerrniEVERET? ADDITIONAL DESCRIPTION(AS NEEDED): CONTACT INFORMATION OWNER/APPLICANT NAME: _'j\V\ \..)00\.\\P„\r- OWNER OWNER/APP. MAILING ADDRESS: STREET On. c j v c) CITY /j��cc' STATE�QWV,. ZIP �`��" ' OWNER/APP.PHONE: Lc)S 422 \lQ u(A. OWNER/APP.EMAIL: W CJI.` 1(--E��yD�\A,O,IIACt.� •U✓v-i CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): 3 EVERETT BUSINESS LICENSE#(_REQUIRED): PRIMARY CONTACT: OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer,Etc.) CONTACT NAME: CONTACT PHONE: 2S 14:-2:2- \(CA-f 0 ----N`\V\ I I a\V_.e trCONTACT EMAIL: �/ )&\ \(\ r M- aCe/14 ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. ork 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 1 am authorized by the owner of this property to perform the work for wh' . ..plication is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only )11."1.1 - / PERMIT# �.,, rr , C�' PW / oll O 51 Owner/Authorized Agent Signature Date (Revised 1/52017)