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111111 1 .1C WORKS PERMIT =PLICATION <br /> EVERETTCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:222 W CASINO RD P6/P7 <br /> IF APPLICABLE: O LAND USE PROJECT#(SEPA,PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: =SFR-DETACHED OSFR-ATTACHED =DUPLEX OMULTI-FAMILY OCOMMERCIAL <br /> CHANGE OF USE? ONO = 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: INSTALL (1) DOUBLE CLASSROOM PORTABLE BUILDING -- S ITE. K <br /> A-Ss©G D t0llNS7f22G/A/ PC-R-779731-6. <br /> = FENCE IN ROW FT IN HEIGHT <br /> O DRIVEWAY APRON/CURB CUT FT WIDE <br /> =ASPHALT/CONCRETE PAVING SF <br /> O RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> O RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> O CLEARING/GRADING/FILL/EXCAVATE CY <br /> = CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> = CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: MUKILTEO SCHOOL DIST 6 <br /> OWNER MAILING ADDRESS: STREET 9401 SHARON DR <br /> cm, EVERETT STATE WA ZIP 98204 <br /> OWNER PHONE: (OWNER EMAIL: <br /> APPLICANT NAME: IAppNamel <br /> APPLICANT MAILING ADDRESS: STREET [AppAdd] <br /> cm' [AppCi] STATE [AppSt] ZIP [AppZip] <br /> APPLICANT PHONE: [AppPhone] (APPLICANT EMAIL: [AppEmail] <br /> PRIMARY CONTACT: = OWNER =APPLICANT = OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME:CONNER SCOTT CONTACT PHONE:2062281014 <br /> CONTACT EMAIL: SCOTT@SCR-ARCH.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 I am authorized by the owner of this property to <br /> perform the wo for which application is made,an I c ply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> j�]� 77- 2-Mt? City of Everett Official Use Only <br /> PERMIT# <br /> PW1907-005 <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br />