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PUbLIC WORKS PERMIT ARLICATION <br /> a—n:g <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov https://everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1 720 W Marine View Drive <br /> SITE WORK FOR PROJECT TYPE: DSFR-DETACHED DSFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY DCOMMERCIAL DINDUSTRIAL <br /> IF APPLICABLE: in LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) SMA 16-001 <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: l� <br /> ❑ FENCE IN ROW (ire" , C�dJ �aC FT IN HEIGHT <br /> l! <br /> ❑ DRIVEWAY APRON/CURB CUT -80 LF Curb FT WIDE PVL_ <br /> I=1 <br /> - - - <br /> ❑ASPHALT/CONCRETE PAVING -2,000 SF Conc. SFD r- " <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL rI ,HT AUG - 6 2018 Li <br /> ❑CLEARING/GRADING/FILL/EXCAVATE -141 CY <br /> CITY Y OF EVERETT <br /> 0 CUT/BORE IN PAVEMENT(PARALLEL) —85 LF LF Permit Services <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> 0 POLE WORK/AERIAL/OVERLASH LF <br /> ADDITIONAL DESCRIPTION(AS NEEDED): <br /> 1-01c, pro) tC j (f it ��bljc IIcc€J$• r�'qquir&riz 1 i1SS�) Gia 'GL rv ,� <br /> �� Pr_orr ca De e/1e -rniyr^t 0✓.epili r /rtes r 0-O 1s) i99-1-w&-°ii <br /> y Op . <br /> -f'Vit�, r. c�r;r� ��? �Pc�r-t- Pr�,� r�.4ciVl � , oi,V�,� Urr�'�rr Ft��i ��;�i�� -- � <br /> CONTACT INFORMATION <br /> OWNER/APPLICANT NAME: Port of Everett <br /> OWNER/APP. MAILING ADDRESS: STREET 1205 Craftsman Way Suite 200 <br /> CITY Everett STATE WA ZIP 98206 <br /> OWNER/APP. PHONE: 425 259 3164 OWNER/APP. EMAIL: eIiseq C1 portofeverett.Com <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STA T= ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 'OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: 425 388 0630 <br /> Elise Gronewald CONTACT EMAIL: eliseg©portofeverett.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 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 /> /y,1T City of Everett Official Use Only <br /> PERMIT# <br /> 1 <br /> ° ` ii,µ C/1 / 2M P W <br /> Owner/Authorized Agent•ignature Date (Revised 1/52017) <br />