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PUBLIC WORKS PERMIT APPLICATION <br /> /1110%‘ 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: 8525 EVERGREEN WAY <br /> IF APPLICABLE: = LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: =SFR-DETACHED =SFR-ATTACHED =DUPLEX =MULTI-FAMILY =COMMERCIAL <br /> CHANGE OF USE? = NO = YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? O NO = YES,TYPE SIZE <br /> SITE WORK I RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: DEMO VILLAGE INN/CONSTRUCT NEW BURGER KING <br /> = FENCE IN ROW FT IN HEIGHT <br /> = DRIVEWAY APRON/CURB CUT FT WIDE <br /> =ASPHALT/CONCRETE PAVING SF <br /> u RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> = RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> = 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: QUINTANA ANTHONY M&DEBORAH G <br /> OWNER MAILING ADDRESS: STREET PO BOX 23152 <br /> crrr FEDERAL WAY STATE WA ZIP 98093 <br /> OWNER PHONE: (OWNER EMAIL: <br /> APPLICANT NAME: STAVERT JEFF <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: 4252522153 (APPLICANT EMAIL: JEFF@2812ARCHITECTURE.COM <br /> PRIMARY CONTACT: = OWNER = APPLICANT = 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 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> PW1 709-047 <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br />