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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:223 BRL1 AVE 3214 Broadway <br /> IF APPLICABLE: o LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: =SFR-DETACHED =SFR-ATTACHED =DUPLEX OMULTI-FAMILY OCOMMERCIAL <br /> CHANGE OF USE? ED NO OYES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? O NO L_J YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: RIGHT OF WAY PERMIT 3214 BROADWAY EVERETT <br /> TO BUILD AND MAINTAIN A FIBER SERVICE BUILDING INSTALLATION IN THE ALLEY BETWEEN BROADWAY AND <br /> LOMBARD <br /> APPROVED AS NOTED See TCP sheet for notes. <br /> By JINISDOM at 7:27:07 AM, 1211712019 <br /> ["-11 CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> 1—1 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: JIRSA WILLIAM G & LEAH M/STACK PATRICIA <br /> OWNER MAILING ADDRESS: STREET 2230 LOMBARD AVE <br /> CITY EVERETT STATE WA ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> APPLICANT NAME: STEVE SZEKELY <br /> APPLICANT MAILING ADDRESS: STREET 1800 41st St <br /> CITY Everett sTATE WA ZIP 98206 <br /> APPLICANT PHONE: 4257123206 APPLICANT EMAIL: STEVE.SZEKELY1@FTR.COM <br /> PRIMARY CONTACT: 17] OWNER L�APPLICANT L7 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: STEVE SZEKELY CONTACT PHONE:4252634018 <br /> CONTACT EMAIL: STEVE.SZEKELY1@FTR.COM <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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> PW1912-025 <br /> ETRAKiT APPLICATION RECEIVED 1211312019 (Revised 313012018) <br />