4613 BAKER DR 2019-06-10 - Laserfiche WebLink

P ft WORKS PERMIT APPLICATION grr CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION p PROJECT ADDRESS: 7 6 13 Pa/(e U rf L°&,. Eire ce n263 SITE WORK FOR PROJECT TYPE: XrSFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL 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 I RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: KFENCE IN ROW FT IN HEIGHT DRIVEWAY APRON/CURB CUT FT WIDE .- VI,ASPHALT/CONCRETE PAVINGr)" (/.31 SF (ec(+/A6t/L, > ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT 0 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): 2Jr5tti.y 6i,--v d .td/� c�u ivka I/t ) 14 L. �ic�fe- Pio.-r SC4p e/1 (J CONTACT INFORMATION OWNER/APPLICANT NAME: �e_c 6-men," 4 OWNER/APP. MAILING ADDRESS: STREET 114D/? dAt 0/` D Jti\/t CITY 6 very..147 �+ STATE (4J 4 ZIP 52a D3 OWNER/APP.PHONE: )06 �a(11-'TgSO OWNER/APP.EMAIL: ...TeYS„f re,,,..y h 0 Cr"4+'Ev.' €.6 m CONTRACTOR NAME: b':‘,41 $4 'p/is" L.,1 ,C- CONTRACTOR ADDRESS: STREET sf02 7 e20 ft'-re.,:tfrr SW CITY 3, G I STATE WA ZIP(7302`/ CONTRACTOR PHONE:dob-6' - 1.{( D CONTRACTOR EMAIL: /I)'p C ee(1 SGS fI es- , GO 41 CONTRACTOR LICENSE#(REQUIRED): t1)I5-6L*t5(N, ') EVERETT BUSINESS LICENSE#(REQUIRED): 577Yq- , PRIMARY CONTACT: 0 OWNER /APPLICANT 0 CONTRACTOR MOTHER(Architect, Engineer, Etc.) fhPZ41ar 4-e C. CONTACT NAME: l /CONTACT PHONE: .2O'j - 33/ - �( ��7 5i1 L- a Yt '' ,✓ CONTACT EMAIL:a`e64--.� /Gi e / ,1J<[;/"A Ar4,4 t 4'4G 4-r r✓"e „GD pi,-) 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 l 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# PW /610 —cp6 Own rized Agent Signature Date (Revised 1/52017)