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0 <br />PUBLIC WORKS PERMIT APLICATION <br />CITY OF EVERETT PERMIT SERVICES <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 SITE INFORMATION <br />PROJECT ADDRESS: 1605 SE Everett Mall Way, Everett WA 98208 <br />IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC) <br />SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI -FAMILY tDCOMMERCIAL ❑INDUSTRIAL <br />CHANGE OF USE? ❑ NO P YES.. FROM General Parking To Electric Vehicle Charging/Parking <br />NEW WATER ! SEWER SERVICE NEEDED? G NO ❑ YES, TYPE SIZE <br />SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION <br />DESCRIPTION OF WORK: Installation of Electric Vehicle Charging Station in existing Wal-Mart Parking lot. <br />❑ FENCE IN ROW NA <br />FT IN HEIGHT <br />❑ DRIVEWAY APRON / CURB CUT NA <br />FT WIDE <br />❑ ASPHALT / CONCRETE PAVING NA <br />SF <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY NA <br />LF <br />❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT NA <br />FT TOTAL HEIGHT <br />❑ CLEARING / GRADING / FILL / EXCAVATE NA <br />CY <br />❑ CUT/BORE IN PAVEMENT (PARALLEL) <br />LF <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) <br />LF <br />CONTACT INFORMATION <br />OWNER NAME: Wal-Mart Real Estate Business Trust <br />OWNER MAILING ADDRESS: STREET 2001 SE 10th Street <br />c,Tv Bentonville STATE AR zip 72716 <br />OWNER PHONE: <br />OWNER EMAIL: <br />APPLICANT NAME: Black & Veatch for Electrify America <br />APPLICANT MAILING ADDRESS: STREET 5885 Meadows Rd Suite 700 <br />ciTv Lake Oswego STATE OR zip 97035 <br />APPLICANT PHONE: 5414903080 APPLICANT EMAIL: suarezc@bv.com <br />PRIMARY CONTACT: ❑ OWNER 7 APPLICANT ❑ OTHER (Architect; Engineer, Etc.) <br />CONTACT NAME: <br />Christina Suarez <br />CONTACT PHONE: 5414903080 <br />CONTACT EMAIL: suarezc@bv.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 1 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 WAG. <br />City of Everett Official Use Only <br />PERMIT # <br />PW Lis*- 0-o <br />Owner/Authorized AgenVsignature Date (Revised 912312016) <br />