1019 112TH ST SW 2019-09-25 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION 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'www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1019 112TH ST SW IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS,ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED. ❑DUPLEX ❑MULTI-FAMILY 12ICOMMERCIAL ❑INDUSTRIAL CHANGE OF USE? El NO 0 YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? El NO 0 YES,TYPE SIZE SITE WORK /RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: Install additional parking area o FENCE IN ROW FT IN HEIGHT ❑DRIVEWAY APRON/CURB CUT FT WIDE pi ASPHALT/CONCRETE PAVING 4,51Q (permeable) SF ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT CLEARING/GRADING/FILL/EXCAVATE 100 cut/100 fill CY ❑CUT/BORE IN PAVEMENT(PARALLEL) LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF frONTACT INFORMATION OWNER NAME: C,v,r..t,u✓,u`i/ Hes; Mn (J e- >iwer.,ZS4 6 .414y OWNER MAILING ADDRESS: STREET ' Q9 Gy ,t•�,I j�/tse / CITY rtl P✓e STATE /4//4 ZIP FP-2,0r OWNER PHONE: '/ZS-, 7 6�Q , 3700 OWNER EMAIL: aoirvl.n4 ,�e,rJ<C-?-S citG9'I m.0�^�i APPLICANT NAME: 2 t " L-P I APPLICANT MAILING ADDRESS: STREET CO' 'eief,.e4,1 tool g CRY et,ei,� STATE f J4 ZIP 9g2 I APPLICANT PHONE: 1/Z,$ 7SeJ, pt) APPLICANT EMAIL: PRIMARY CONTACT: 0 OWNER 0 APPLICANT OTHER(Architect, Engineer, Etc.) Western Eng.&Surveyors CONTACT NAME: CONTACT PHONE: 425-356-2700 Jesse Jarrell CONTACT EMAIL: jeSSej@WeSi.co 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 pf 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 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 -_y PERMIT# -- g PW t5o3 - olq Owner/Authorized Agent Signature Date (Revised 9/23/2016)