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PUBLIC WORKS PERMIT APPLICATION <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 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION_ <br /> PROJECT ADDRESS:2727 BROADWAY AVE <br /> IF APPLICABLE: = LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: =SFR-DETACHED =SFR-ATTACHED =DUPLEX =MULTI-FAMILY =COMMERCIAL <br /> CHANGE OF USE? = NO = YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? = NO = YES,TYPE SIZE <br /> SITE WORK RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: MCI Metro Franchise Permit# 1801AUJE.1 ROW EVT 0582 <br /> INSTALLATION OF 379 LF OF 2" HDPE CONDUIT, (2)VAULTS AND PULL FIBER CABLE IN THE RIGHT-OF-WAY OF <br /> (2000-2100) CALIFORNIA ST. INSTALLATION VIA(364 LF) OF DIRECTIONAL BORING IN THE RIGHT-OF-WAY&(15 LF) <br /> OF TRENCHING IN SOFT SOIL. <br /> APPROVED See TCP sheets for notes and restrictions. <br /> By JWISDOM'at 11:27:08 AM,112412019 <br /> CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> = CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: POLLARD VELTA B LIVING TRUST <br /> OWNER MAILING ADDRESS: STREET 11021 CHAMPAGNE ROAD NE <br /> CITY KIRKLAND STATE WA zip 98034 <br /> OWNER PHONE: OWNER EMAIL: <br /> APPLICANT NAME: Arnaldo Blanco <br /> APPLICANT MAILING ADDRESS: STREET 3000, E Cesar Chavez St. <br /> CITY Austin STATE TX ZIP 78702 <br /> APPLICANT PHONE: 7873492960 APPLICANT EMAIL: ablanco@fg-inc.net <br /> PRIMARY CONTACT: 0 OWNER- =APPLICANT - = OTHER(Architect,Engineer, Etc.) <br /> CONTACT NAME:Arnaldo Blanco CONTACT PHONE:7873492960 <br /> CONTACT EMAIL: ablanco@fg-inc.net <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 /> PW1901-057 <br /> ETRAKiT APPLICATION RECEIVED 112212019 (Revised 313012018) <br />