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V Fl ppm WsRKS PEW -111T A PLIc'ATION <br /> „ <br /> . , , CITY OF EVERETT PERMIT "VICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> :.. PROJECT SIITE INFORMATION <br /> PROJECT ADDRESS: 2915 36TH STREET, EVERETT, WA 98201 <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY DCOMMERCIAL IXIINDUSTRIAL <br /> CHANGE OF USE? KI NO ❑YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? ® NO 0 YES,TYPE SIZE <br /> SITE WORK) RIGHT-OF WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: GRADING AND PLACEMENT OF FILL FOR FUTURE DEVELOPMENT <br /> ❑FENCE IN ROW FT IN HEIGHT <br /> ❑DRIVEWAY APRON/CURB CUT FT WIDE <br /> ❑ASPHALT/CONCRETE PAVING SF <br /> 365- I®1 tem <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF • 4, 1,3 602 17 <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> ❑ CLEARING.RADING/FIi EXCAVATE 27,000 CY FILL CY Sd I /,7X 8a <br /> ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> 0 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION . <br /> OWNER NAME: DELTA TIDELANDS, LLC. <br /> OWNER MAILING ADDRESS: STREET 701 FIFTH AVENUE, SUITE 3600 <br /> crry MUKILTEO STATE WA Z,P 98275 <br /> OWNER PHONE: OWNER EMAIL: <br /> APPLICANT NAME: CJ EBERT <br /> APPLICANT MAILING ADDRESS: STREET 2911 1/2 HEWITT AVE <br /> crry EVERETT STATE WA ZIP 98201 <br /> APPLICANT PHONE: 425 258 9366 MN APPLICANT EMAIL: CJEBERT@HARBORMOUNTAINDEV,COM <br /> PRIMARY CONTACT: 0 OWNER NI APPLICANT 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: _ <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 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 /> sj <br /> City of Everett Official Use Only <br /> PERMIT# <br /> _.,-=—. —/ / i� MVV Q <br /> Owner/Authoried Agent Signature ., ate (Revised 10/12/2016) <br />