1223 LOMBARD AVE 2019-06-25 - Laserfiche WebLink

PLIC WORKS PERMIT A'LICATION 47Ferr CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROD CT. e_ CT PROJECT ADDRESS: /22.3 lyj6��P /5.1-kr L SITE WORK FOR PROJECT TYPE: SFR-DETACHED EISFR-ATTACHED El DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL 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 6 Ai_ 1 J+(y JJ- FT IN HEIGHT ❑DRIVEWAY APRON/CURB CUT FT WIDE ❑ASPHALT/CONCRETE PAVING SF ❑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 �r OWNER/APPLICANT NAME: �I ,2)/.711.4,e___ OWNER/APP. MAILING ADDRESS: STREET �j 'mbAr ( A CITY / STATE vZIP � eS7 4/ OWNER/APP.PHONE: --7370-82&'6 'OW (./ 9'!NER/APP.EMAIL: 721 Who?,23,4:2_,.. 70„7, On,g.� CONTRACTOR NAME: / $/ A A4c 3hcYii_1 m _ CONTRACTOR ADDRESS: STREET '"1r ..1% 72.9 7 . c � r ' �// CITY �yrj 5v,•(( STATE /n ZIP Bialy CONTRACTOR PHONE: / !!! SSS" 7 CONTRACTOR EMAIL: ,417Z2es,'An ,y Z-!�(�e,741/0,/ .ea"- CONTRACTOR LICENSE#(REQUIRED): 4/(pw n�g`j Oq/4 EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ffd"OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT NAM : CONTACT PHONE: �- c— G -7/ IM CONTACT EMAIL: /410_,-/Lm, ' , -(S ACKNOWLEDGEMENT::I have reviewed this application and confirm the information contained herein is true and correct. Work� ,y,�,Vursuant 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.l am the owner,or 1 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 68ogvo i(a . Owner/Authorized Agent Signature Date (Revised 1/52017)