2930 MAPLE ST 2023-12-27 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I https:Heverettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2930 Maple Street SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY BCOMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) EPPLI CABLE: 11FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB M JOB# 5695 DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: ❑ 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 ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF ❑ POLE WORK/AERIAL/OVERLASH LF ADDITIONAL DESCRIPTION (AS NEEDED): Potholing utilities to obtain a depth for design . CONTACT INFORMATION OWNER/APPLICANT NAME: JOHN GARDIN OWNER/APP. MAILING ADDRESS: STREET 43530 SE NORTH BEND WAY ciTY NORTH BEND STATE WA zip 98045 OWNER/APP. PHONE: 425-864-5547 OWNER/APP. EMAIL: JOHNIGODAPSLOCATES.COM CONTRACTOR NAME: APPLIED PRFOESSIONAL SERVICES CONTRACTOR ADDRESS: STREET 43530 SE NORTH BEND WAY ciTY NORTH BEND STATE WA zip 98045 CONTRACTOR PHONE: 425-864-5547 CONTRACTOR EMAIL: JOHNG@APSLOCATES.COM CONTRACTOR LICENSE#(REQUIRED): APPLIPS981 LD EVERETT BUSINESS LICENSE#(REQUIRED): 042071 PRIMARY CONTACT: ® OWNER /APPLICANT ❑ CONTRACTOR ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 425-864-5547 JOHN GARDIN CONTACT EMAIL: JOHNG APSLOCATES.COM ACKNOWLEDGEMENT.1 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.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made,and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PER�M/IIT�# "� C• �� 10/29/2020 PW V Owner/Authorized Agent Signature Date (Revised 1/52017)