8620 HOLLY DR 2021-12-21 - Laserfiche WebLink

• OLT PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 8620 HOLLY DRIVE IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) SITE WORK FOR PROJECT TYPE:DSFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY 2ICOMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 1Z1 NO ❑YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? l NO ❑ YES,TYPE SIZE SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: APS TO POTHOLE EXISTING UTILITIES TO DETERMINE DEPTH AND LOCATION FOR DESIGN PURPOSES FOR THE AIR VALVE REPLACEMENT PROJECT FOR ALDERWOOD WATER DISTRICT ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ASPHALT/CONCRETE PAVING SF ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑ CLEARING/GRADING/FILL/EXCAVATE CY p CUT/BORE IN PAVEMENT(PARALLEL) 8„X8„ LF VCUT/BORE IN PAVEMENT(NON-PARALLEL) 8"X8" LF CONTACT INFORMATION OWNER NAME: CITY OF EVERETT OWNER MAILING ADDRESS: STREET 3200 CEDAR ST ciTy EVERETT STATE WA Z,P 98201 OWNER PHONE: 425-888-2590 OWNER EMAIL: JOHNG@APSLOCATES.COM APPLICANT NAME: JOHN GARDIN APPLICANT MAILING ADDRESS: STREET 43530 SE NORTH BEND WAY cirr NORTH BEND STATE WA ZIP 980345 APPLICANT PHONE:425-864-55547 APPLICANT EMAIL: JOHNG@APSLOCATES.COM PRIMARY CONTACT: ❑OWNER r27 APPLICANT ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 425-864-5547 JOHN GARDIN CONTACT EMAIL: 425-888-2590 ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must 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 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 perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. n City of Everett Official Use Only PERMIT# Owner/Authorized Agent Signature Date (Revised 9/23/2016)