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ABLIC WORKS PERMIT A*LICATION <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 https://everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 17 East Marine Drive, Everett, WA 98201 <br />rf <br />SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI -FAMILY ❑COMMERCIAL ZINDUSTRIAL <br />IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) Pre-App#18-,MW—a,")1'-1 <br />IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT # <br />UTILITY COMPANY'S NAME & JOB #: JOB # <br />DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />❑ FENCE IN ROW FT IN HEIGHT <br />❑ DRIVEWAY APRON / CURB CUT FT WIDE <br />❑ ASPHALT / CONCRETE PAVING SF <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF <br />❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br />16 CLEARING / GRADING / FILL / EXCAVATE 2,199 (cut), 97 (fill), 2,102 (net cut) Cy <br />❑ CUT/BORE IN PAVEMENT (PARALLEL) LF <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF <br />❑ POLE WORK / AERIAL / OVERLASH LF <br />ADDITIONAL DESCRIPTION (AS NEEDED): <br />CONTACT INFORMATION <br />OWNER / APPLICANT NAME: Cadman Materials Attu: Christy McDonough) <br />OWNER / APP. MAILING ADDRESS: STREET 7554 185th Avenue NE, Suite 100 <br />clTv Redmond STATE WA z,P 98052 <br />OWNER / APP. PHONE: 425-698-3226 <br />OWNER / APP. EMAIL: Christy. McDonouh Lehi hHanson.com <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />I CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />EV ERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: OWNER / APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: <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. i am the owner, or / am authorized by the owner of this property to <br />perform the work for which application is made, and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Owner/Authorized Agent <br />Date <br />City of Everett Official Use Only <br />PERMIT # <br />1 PWI�eq-0,3/ <br />(Revised 1152017) <br />(17— <br />