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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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:6320 EVERGREEN WAY <br /> IF APPLICABLE: O LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: O SFR-DETACHED =SFR-ATTACHED O DUPLEX =MULTI-FAMILY 0 COMMERCIAL <br /> CHANGE OF USE? E-1 NO OYES, 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: MCI Metro Franchise Permit#1801AVAO.24 ROW EVT 1018 <br /> Installation of 13 LF of 2" HDPE conduit, (1)vault and pull fiber optic cable in the Right-of-Way at 6320 Evergreen Way. <br /> Installation via (13 LF) of directional boring in the Right-of-Way. <br /> APPROVED �r'!Ni2 �1 ,y/.�„� See TCP sheet for notes. <br /> By JWISDOM at 6:28:36 AM,41812019 <br /> = CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> 0 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: WILLIAMS DOUGLAS&GEORGENE <br /> OWNER MAILING ADDRESS: STREET 6320 EVERGREEN WAY STE A <br /> CITY EVERETT STATE WA zip 98203 <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: O OWNER APPLICANT 0 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 /> PW1904-009 <br /> ETRAKiT APPLICATION RECEIVED 4/5/2019 (Revised 313012018) <br />