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PUBLIC WORKS PERMIT 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 1t <br /> PROJECT ADDRESS:3501 UPLAND AVE <br /> IF APPLICABLE: o LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: OSFR-DETACHED OSFR-ATTACHED =DUPLEX O MULTI-FAMILY =COMMERCIAL <br /> CHANGE OF USE? ONO O YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? O NO O YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: NEW SFR-DETACHED/SITE DEVELOPMENT <br /> CI 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 /> CLEARING/GRADING/FILL/EXCAVATE CY <br /> O CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> O CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: GORDON HOMES LLC <br /> OWNER MAILING ADDRESS: STREET 9420 31ST AVE SE <br /> crry EVERETT STATE WA ZIP 98208 <br /> OWNER PHONE:4258761130 'OWNER EMAIL: <br /> APPLICANT NAME: GORDON HOMES LLC <br /> APPLICANT MAILING ADDRESS: STREET 9420 31ST AVE SE <br /> ciT' EVERETT STATE WA ZIP 98208 <br /> APPLICANT PHONE: 4258761130 (APPLICANT EMAIL: <br /> PRIMARY CONTACT: O OWNER O APPLICANT O OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: [ContactName] CONTACT PHONE: [ContactPhone] <br /> CONTACT EMAIL: [ContactEmail] <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 6f 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 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 /> PW1708-039 <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br />