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POBLIC WORKS PERMIT 'PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> . PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1907 W MUKILTEO BLVD <br /> IF APPLICABLE: I I LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: OSFR-DETACHED OSFR-ATTACHED CIDUPLEX OMULTI-FAMILY CICOMMERCIAL <br /> CHANGE OF USE? O NO O YES, 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: STABILIZE SLOPE WITH SOLDIER PILE WALL <br /> O FENCE IN ROW FT IN HEIGHT <br /> O DRIVEWAY APRON/CURB CUT FT WIDE <br /> OASPHALT/CONCRETE PAVING SF <br /> O RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF t I,,I i,7-hoopoe iivederRETAINING WALL/ROCKERY OVER 4FT IN HEIGHT 113,LF )�I1p, 1►f j W^ FT TOTAL HEIGHT `t'� '� 01C,'ten <br /> O CLEARING/GRADING/FILL/EXCAVATE CY X c 433, 7) <br /> O CUT/BORE IN PAVEMENT(PARALLEL) LF l� <br /> O CUT/BORE IN PAVEMENT(NON-PARALLEL) ,LF 4 zerem kg-vitai <br /> CONTACT INFORMATION <br /> OWNER NAME: CONNELL HERBERT E& ROSAMARIE T <br /> OWNER MAILING ADDRESS: STREET 1907 W MUKILTEO BLVD <br /> cnY EVERETT STATE WA ZIP 98203 <br /> OWNER PHONE: [OWNER EMAIL: <br /> APPLICANT NAME: JAMES BEN <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: 4257788500 (APPLICANT EMAIL: BENJ@CGENGINEERING.COM <br /> PRIMARY CONTACT: O OWNER I APPLICANT O OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: [ContactName] CONTACT PHONE: [ContactPhone] <br /> CONTACT EMAIL: [ContactEmail] <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 /> PERMIT# <br /> PW1 808-073 <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br /> ;f" <br />