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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:4001 SMITH AVE <br /> IF APPLICABLE: O LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:OSFR-DETACHED OSFR-ATTACHED =IDUPLEX MULTI-FAMILY =COMMERCIAL <br /> CHANGE OF USE? o NO o YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? O NO 0 YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: MCI Metro Franchise Permit#1703MNTR.004 ROW EVT 1332 <br /> INSTALLATION OF 539 LF OF 2 INCH HDPE CONDUIT, (3)VAULTS &PULL FIBER CABLE IN THE RIGHT-OF-WAY OF <br /> SMITH AVE. INSTALLATION VIA(521 LF)OF DIRECTIONAL BORING IN THE RIGHT-OF-WAY, (18 LF) OF TRENCHING IN <br /> SOFT SOIL. <br /> See TCP sheets for notes, also for granting access through the City <br /> APPROVED of Everett gate under 41 st St contact Pat Mitchal @ 425-418-0426 to <br /> ByJWISDO at9:56:01 AM,5/8/2019 unlock gate. <br /> O CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> O CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: HIGGINS CAROLYNN <br /> OWNER MAILING ADDRESS: STREET 4001 SMITH AVE <br /> CITY EVERETT STATE WA zip 98201 <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 O APPLICANT O OTHER(Architect,Engineer, Etc.) <br /> CONTACT NAME:Aaron Ledvina CONTACT PHONE:2067156372 <br /> CONTACT EMAIL: aledvina@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 /> PW1905-002 <br /> ETRAKIT APPLICATION RECEIVED 5r2/2019 (Revised 313012018) <br />