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PUOLIC WORKS PERMIT A LICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 801 E CASINO RD <br />IF APPLICABLE: = LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) <br />SITE WORK FOR PROJECT TYPE: 0 SFR-DETACHED O SFR-ATTACHED 0 DUPLEX O MULTI -FAMILY 0 COMMERCIAL <br />CHANGE OF USE? = NO 0 YES, FROM TO <br />NEW WATER / SEWER SERVICE NEEDED? o NO o YES, TYPE SIZE <br />SITE WORK 1 RIGHT -Of -WAY APPLICATION INFORMATION <br />DESCRIPTION OF WORK: SITEWORK FOR (4) NEW PORTABLES -CASCADE HIGH <br />E-1 FENCE IN ROW <br />FT IN HEIGHT <br />O DRIVEWAY APRON / CURB CUT <br />FT WIDE <br />ASPHALT/ CONCRETE PAVING <br />SF <br />o RETAINING WALL / ROCKERY IN RIGHT-OF-WAY <br />LF <br />0 RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT <br />FT TOTAL HEIGHT <br />o CLEARING / GRADING / FILL / EXCAVATE <br />CY <br />O CUT/BORE IN PAVEMENT (PARALLEL) <br />LF <br />O CUT/BORE IN PAVEMENT (NON -PARALLEL) <br />LF <br />CONTACT INFORMATION <br />OWNER NAME: EVERETT SCHOOL DIST 2 <br />OWNER MAILING ADDRESS: STREET <br />4730 COLBY AVE <br />CITY <br />EVERETT STATE WA zip 98203 <br />OWNER PHONE: <br />APPLICANT NAME: HAM ZACH <br />OWNER EMAIL: <br />APPLICANT MAILING ADDRESS: STREET <br />CITY <br />STATE ZIP <br />APPLICANT PHONE: 4252593161 APPLICANT EMAIL: ZACHH@DYKEMAN.NET <br />PRIMARY CONTACT: = OWNER 0 APPLICANT = OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: HAM ZACH <br />CONTACT PHONE: 4252593161 <br />CONTACT EMAIL: ZACHH@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. 1 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 />Authorized Agent/Owner Date <br />City of Everett Official Use Only <br />PERMIT # <br />PW1910-003 <br />(Revised 1011212015) <br />