3315 BROADWAY HOPEWORKS STATION 2 2020-12-21

PUBLIC WiRKS PERMIT APPUICATI•N sitict CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 3315 3 it-04PWAY IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA,PRE-APP, SS, ETC.) Wit 14-O001 56PIA 11-oO(O SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED DDUPLEX DMULTI-FAMILY COMMERCIAL Di INDUSTRIAL CHANGE OF USE? 0 NO ki YES, FROM $FIG -VACA - TO CO MMMMtgfA'Gbit uN'I- F4•M I Ley NEW WATER/SEWER SERVICE NEEDED? 0 NO p.YES,TYPE SIZE SITE WORK/RIGHT-OF-WAY APPWGATION INFORMATION DESCRIPTION OF WORK: NEW WASVfl- 5CriAtto& - ant0APIVR•Y Nev-1 4www. pnAwA-se - A' Y pe(L'7'n oAD 3 K5r" 15(1124"'o/I-td and-Ate", 6 rsra..Or vC ❑ FENCE IN ROW FT IN HEIGHT I RIVEWAY APRON/CURB CUT 24) FT WIDE 0 ASPHALT/CONCRETE PAVING SF ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑CLEARING/GRADING/FILL/EXCAVATE l lob(o CY ❑CUT/BORE IN PAVEMENT(PARALLEL) LF ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF - CONTACT INFORMATION OWNER NAME: Hvery or 4c5 OWNER MAILING ADDRESS: STREET 33�3y1�yI't-3'$corzw CY 1 CITY V'E�'L6-Y @ STATE H+I} ZIP et$201 OWNER PHONE: 4Z5 Me 4131 OWNER EMAIL: M & htPewOAk'"area • ___ �' �___ APPLICANT NAME: 9C1JG, kip P I V S , PY.EW'A.- Aft '-gr 4 APPLICANT MAILING ADDRESS: STREET I"TI(O v • PA&VINE V I eVV Pi"V e CRY E V EfleTT STATE wt_t ZIP ZO I APPLICANT PHONE: * S 15g (p I APPLICANT EMAIL Cc1 yt i�CJ'NOIYi• NCI- --- PRIMARY CONTACT: ❑ OWNER APPLICANT ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 40 474*j 2.61 31 to Pave Ft,ct VS CONTACT EMAIL: ADu In a ot.s ke s^an• tet ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein I rue and correct Work done pursuant to this permit must 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 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 perform the work for which application is made,and I comply with the State Contractors Law 1527 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# W ^�T— I2 ' I1 • 2a17 PW ( a-oao Owner/Authorized�rk gnature Date (Revised 10/12/2015)