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047T PUBLIC WORKS PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> p PROJECT SITE'INFORMATION <br /> PROJECT ADDRESS:.� 41W <br /> A _COLBY- E- See_ +-' St SE <br /> IF APPLICABLE: CI LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: I-1SFR-DETACHED LA SFR-ATTACHED IDUPLEX =MULTI-FAMILY =COMMERCIAL <br /> CHANGE OF USE? L-A- NO = YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? n NO I YES.TYPE SIZE <br /> SITE WORK I RIGHT OF.. 1 \ asCATION INFORMATION <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW SFR <br /> = FENCE IN ROW FT IN HEIGHT <br /> O DRIVEWAY APRON/CURB CUT FT WIDE <br /> =ASPHALT/CONCRETE PAVING SF <br /> n RETAINING WALL/ ROCKERY IN RIGHT-OF-WAY LF <br /> O RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT_ FT TOTAL HEIGHT <br /> = CLEARING/GRADING/FILL/EXCAVATE CY <br /> CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> L CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> OWNER NAME: D&G HOPKINS LLC <br /> OWNER MAILING ADDRESS: STREET 13220 47TH AVE SE <br /> ciTY MILL CREEK STATE WA ZIP 98012 <br /> OWNER PHONE: (OWNER EMAIL: <br /> APPLICANT NAME: GLACIER VIEW PROPERTIES <br /> APPLICANT MAILING ADDRESS: STREET 10121 EVERGREEN WY STE 25-165 <br /> cmi EVERETT STATE WA ZIP 98204 <br /> APPLICANT PHONE: (APPLICANT EMAIL: <br /> PRIMARY CONTACT: I OWNER = APPLICANT L OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: ALLEN RON CONTACT PHONE:4255084380 <br /> CONTACT EMAIL: ronallen3431@yahoo.com <br /> ACKNOWLEDGEMENT 1 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 I 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 /> PW 1711-032 <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br />