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PLIC WORKS PERMIT I4PPLICATION <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: 316 SE EVERETT MALL WAY <br /> IF APPLICABLE: O LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: O SFR-DETACHED O SFR-ATTACHED O DUPLEX 0 MULTI-FAMILY COMMERCIAL <br /> CHANGE OF USE? 1�j NO 0 YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? ) NO O YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: SITE WORK FOR TI-MCDONALDS <br /> = FENCE IN ROW FT IN HEIGHT <br /> O DRIVEWAY APRON/CURB CUT FT WIDE <br /> ASPHALT/CONCRETE PAVING SF <br /> O RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> o RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> = CLEARING/GRADING/FILL/EXCAVATE CY <br /> O CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> o CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: MCDONALD'S REAL ESTATE CO LC04 <br /> OWNER MAILING ADDRESS: STREET PO BOX 182571 <br /> CITY COLUMBUS STATE OH zip 43218 <br /> OWNER PHONE: OWNER EMAIL: <br /> APPLICANT NAME: FREIHEIT&HO ARCHITECTS <br /> APPLICANT MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: D OWNER D APPLICANT = OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: [ContactName] CONTACT PHONE: [ContactPhone] <br /> CONTACT EMAIL: [ContactEmail] <br /> ACKNOWLEDGEMENT:1 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. 1 am the owner, or 1 am authorized by the owner of this property to <br /> perform the wor for which applications made, and t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> '{Yl1Ya1 Tl'�I f- _ 1cW owed 6tyn b/9 Pc City of Everett Official Use Only <br /> PERMIT# <br /> PW1609-085 <br /> Authorized Agent/Owner Date (Revised 10/1212015) <br />