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PUBLIC WORKS PERMIT APPLICATION <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: 3301 LOMBARD AVE <br />IF APPLICABLE: o LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) <br />SITE WORK FOR PROJECT TYPE: 0 SFR-DETACHED E--I SFR-ATTACHED L--I DUPLEX O MULTI -FAMILY O COMMERCIAL <br />CHANGE OF USE? I= NO OYES, FROM TO <br />NEW WATER / SEWER SERVICE NEEDED? o NO o YES, TYPE SIZE <br />SITE WORK /`RIGHT-OF-WAY APPLICATION INFORMATION <br />DESCRIPTION OF WORK: SITE WORK FOR NEW MULTI -FAMILY BUILDING <br />o FENCE IN ROW <br />FT IN HEIGHT <br />= DRIVEWAY APRON / CURB CUT <br />FT WIDE <br />oASPHALT/ CONCRETE PAVING <br />SF <br />O RETAINING WALL / ROCKERY IN RIGHT-OF-WAY <br />LF <br />o RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT <br />FT TOTAL HEIGHT <br />o CLEARING / GRADING / FILL / EXCAVATE <br />CY <br />0 CUT/BORE IN PAVEMENT (PARALLEL) <br />LF <br />0 CUT/BORE IN PAVEMENT (NON -PARALLEL) <br />LF <br />CONTACT INFORMATION <br />OWNER NAME: COMPASS HEALTH <br />OWNER MAILING ADDRESS: STREET 4526 Federal Avenue MS#30 <br />CITY EVERETT STATE WA zip 98203 <br />OWNER PHONE: 4253498413 OWNER EMAIL: tom.sebastian@compassh.org <br />APPLICANT NAME: ENVIRONMENTAL WORKS <br />APPLICANT MAILING ADDRESS: STREET 402 15th Ave East <br />CITY SEATTLE STATE WA ZIP 98122 <br />APPLICANT PHONE: 2067871369 APPLICANT EMAIL: ccongdon@eworks.org <br />PRIMARY CONTACT: 0 OWNER I—] APPLICANT = OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: CHRISTINA CONGDON <br />CONTACT PHONE: 2067871369 <br />CONTACT EMAIL: ccongdon@eworks.org <br />ACKNOWLEDGEMENT: 1 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 1 am authorized by the owner of this property to <br />perform the work for whigh 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 />PW1907-020 <br />(Revised 1011212015) <br />