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OLT . JBLIC WORKS PERM('- APPLICATION <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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 5304 FLEMING RD A& B <br /> IF APPLICABLE: I I LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: =SFR-DETACHED CI SFR-ATTACHED ( (DUPLEX1 <br /> L_ MULTI-FAMILY OCOMMERCIAL <br /> CHANGE OF USE? o NO O YES, FROM TO <br /> I <br /> NEW WATER/SEWER SERVICE NEEDED? I 1 NO n YES,TYPE SIZE <br /> SITE WORK I"RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW DUPLEX <br /> O 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 /> O CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: HAACK BROTHERS INC <br /> OWNER MAILING ADDRESS: STREET 3922 87TH AVE NE <br /> ciry MARYSVILLE STATE WA ZIP 98270 <br /> OWNER PHONE: (OWNER EMAIL: <br /> 'mss, <br /> APPLICANT NAME: HAACK BROTHERS INC <br /> APPLICANT MAILING ADDRESS: STREET 3922 87TH AVE NE <br /> cn- MARYSVILLE STATE WA ZIP 98270 <br /> APPLICANT PHONE: (APPLICANT EMAIL: <br /> PRIMARY CONTACT: O OWNER O APPLICANT O OTHER (Architect, Engineer, Etc.) <br /> CONTACT NAME: JOEL HAACK CONTACT PHONE:4252902429 <br /> CONTACT EMAIL: joel@haackbrothers.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 work for which application is made, and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> PW1812-051 <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br />