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PLIC WORKS PERMIT A'LICATION
<br /> OrEETTCITY 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 I https://everettwa.gov/permits
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<br /> z f ,r ,E,,..,, �,;XV: :.,rte ,�.� , ,,..: ,.PR4JECT SITE INFORMATION r '.< ;"E3..r " t., ,,,,„otwo,,, hz
<br /> PROJECT ADDRESS:2910 SEAWAY, EVERETT,WA 98203
<br /> SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑✓COMMERCIAL ❑INDUST.
<br /> IF APPLICABLE: ❑LAND USE PROJECT#(SEPA, PRE-APP,SS,ETC.)
<br /> IF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT#
<br /> UTILITY COMPANY'S NAME&JOB#: 6Q.A�v I Ci. /l 1,ted h#
<br /> '... . ', _ iDESC.RIPt;1o'kt tv:ATE„WORK,/RIGI'tt43TF 11'AYViibRK . .,Ef: , ,,,,
<br /> FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE:
<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 /> ❑✓ CLEARING/GRADING/FILL/EXCAVATE CY
<br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF
<br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF
<br /> ❑POLE WORK/AERIAL/OVERLASH LF
<br /> ADDITIONAL DESCRIPTION(AS NEEDED):
<br /> The Service Road from the 40-41 building to the 40-201 (Activity Center building)has trees near the road that have been determined to be a safety issue
<br /> and need to be removed. See attached sheets for reference.
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<br /> 6: „,F t rµ`is.x„ , ,-CONTACT INFORMATION „ $tv.
<br /> OWNER/APPLICANT NAME:Todd Haberlack
<br /> OWNER/APP. MAILING ADDRESS: STREET PO Box 3707 M/S OH-13
<br /> crry Seattle STATE Wa ZIP 98124-2207
<br /> OWNER/APP.PHONE:425-260-2668 OWNER/APP.EMAIL:todd.j.haberlack@boeing.com
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: ❑✓ OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.)
<br /> CONTACT NAME: CONTACT PHONE:425-260-2668
<br /> Todd Haberlack CONTACT EMAIL:todd.j.haberlack@boeing.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.lam the owner,or lam 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 /> ` "_Z.', // // PERMIT Z0? PW IRb `'b I�
<br /> Owner/Authorized Agent Signature Date (Revised 1/5/2017)
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