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PLtIC WORKS PERMIT A!LICATION <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:3315 BROADWAY <br /> IF APPLICABLE: O LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: =SFR-DETACHED OSFR-ATTACHED O DUPLEX =MULTI-FAMILY =COMMERCIAL <br /> CHANGE OF USE? = NO = YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? = NO = YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: SITE WORK, STORM DRAINAGE FOR NEW BLDG <br /> = FENCE IN ROW FT IN HEIGHT <br /> = DRIVEWAY APRON/CURB CUT FT WIDE <br /> =ASPHALT/CONCRETE PAVING SF <br /> O RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> = RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> O CLEARING/GRADING/FILL/EXCAVATE CY <br /> = CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> = CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: HOPEWORKS SOCIAL ENTERPRISES <br /> OWNER MAILING ADDRESS: STREET 5830 EVERGREEN WAY <br /> cnv EVERETT STATE WA ZIP 98203 <br /> OWNER PHONE: (OWNER EMAIL: <br /> APPLICANT NAME: DOUG HOFIUS DYKEMAN ARCHITECTS <br /> APPLICANT MAILING ADDRESS: STREET 1716 W MARINE VIEW DR <br /> cm, EVERETT STATE WA ZIP 98201 <br /> APPLICANT PHONE: 4252593161 (APPLICANT EMAIL: dough@dykeman.net <br /> PRIMARY CONTACT: O OWNER = APPLICANT O OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: DOUG HOFIUS DYKEMAN CONTACT PHONE:4252593161 <br /> ARCHITECTS <br /> CONTACT EMAIL: dough@dykeman.net <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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> PW1712-020 <br /> Authorized AgenVOwner Date (Revised 10/12/2015) <br />