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41677 PLLIC WORKS PERMIT PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov ( www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:6133 LAKE CHAPLAIN RD <br /> IF APPLICABLE: = LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: =SFR-DETACHED =SFR-ATTACHED =DUPLEX ElMULTI-FAMILY =COMMERCIAL <br /> CHANGE OF USE? = NO = YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? = NO = YES,TYPE SIZE <br /> SITE WORK!RIGHT OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: INSTALLATION OF REPLACEMENT TELECOM LINE <br /> = FENCE IN ROW 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 /> LEARING/GRADING/FILL/EXCAVATE CY <br /> CUT/BORE IN PAVEMENT(PARALLEL) 4%z- LF <br /> = CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: EVERETT CITY OF <br /> OWNER MAILING ADDRESS: STREET 3002 WETMORE AVE <br /> CITY EVERETT STATE WA ZIP 98201 <br /> OWNER PHONE: 'OWNER EMAIL: <br /> APPLICANT NAME: SNOHOMISH COUNTY PUD#1 <br /> APPLICANT MAILING ADDRESS: STREET PO BOX 1107 <br /> CITY EVERETT STATE WA ZIP 98201 <br /> APPLICANT PHONE: 4257835627 IAPPLICANT EMAIL: MGMCREYNOLDS@SNOPUD.COM <br /> PRIMARY CONTACT: = OWNER =APPLICANT = OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME:SNOHOMISH COUNTY PUD#1 CONTACT PHONE:4257835627 <br /> PflO-RCUpl CONTACT EMAIL: MGMCREYNOLDS@SNOPUD.COM <br /> ACKNOWLEDGEMENT:I haVe reviewed this application and confirm the information contained herein is true and correct. Work done pursuant 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.I am the owner,or 1 am 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 /> PW1811-005 <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br />