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PI IC WORKS PERMIT AAPLICATION <br />CITY OF EVERETT PERMIT SER ICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT ADDRESS: 2514 RAINIER AVE <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? = NO = YES, TYPE SIZE <br />(DESCRIPTION OF WORK: SITEWORK FOR SCHOOL MODERNIZATION -NORTH MIDDLE SCHOOL <br />= FENCE IN ROW FT IN HEIGHT <br />= DRIVEWAY APRON / CURB CUT FT WIDE <br />=ASPHALT/ CONCRETE PAVING SF ((3 + rq <br />= RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LFZvi <br />= RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIG <br />= CLEARING / GRADING / FILL / EXCAVATE CYr' <br />y:l <br />= CUT/BORE IN PAVEMENT (PARALLEL) LF C/ f-r Op SV% <br />= CUT/BORE IN PAVEMENT (NON -PARALLEL) LF Perrni t:RE7-r <br />�rvices <br />MAILING ADDRESS: <br />STREET 4730 COLBY AVE <br />CITY EVERETT STATE WA zip 98203 <br />OWNER PHONE: OWNER EMAIL: <br />...o.... �...:. - -�s�� ._ti,___F ,.,,.: ���.. ?` •; ..\i f;Eik�.e .. emu.... ,.7 .�.:..� s/.Y� �....,9 � >1'� t.._.,., :. '' _ _.... � .. ,T .. _,:. .. .. <br />APPLICANT NAME: GIFFORD MARK <br />APPLICANT MAILING ADDRESS: STREET <br />CITY STATE ZIP <br />APPLICANT PHONE: 2064414522 [APPLICANT EMAIL: MGIFFORD(a)-NACARCHITECTURE.COM <br />PRIMARY CONTACT: = OWNER = APPLICANT = OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: GIFFORD MARK 1CONTACT PHONE: 2064414522 <br />CONTACT EMAIL: MGIFFORD@NACARCHITECTURE.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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />00��� 1 1 EP <br />IT # <br />W1711-004 <br />Authorize ent/Owner Date (Revised 1011212015) <br />