915 N BROADWAY BASE FILE 2017-12-21

R�•APR.1c�crTiA+J CoQ �PII� I�PI�tT PWIg12-o23 t PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:911 N BROADWAY, EVERETT, WA 98201 IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? ❑NO ❑YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? ❑ NO ❑YES,TYPE SIZE SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: REMOVE OH CONDUCTOR COVERS ON OVERHEAD LINES PREVIOUSLY INSTALLED ON EVERETT PUBLIC WORKS PERMIT PW1512-023(SEE ATTACHED). ONE LANE OF TRAFFIC WILL BE CLOSED FOR APPROXIMATELY 2 HRS.WORK WILL BE DONE IN CONJUNCTION WITH NEW EVCC/WSU BUILDING. Wol 10wooms-oviv ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ASPHALT/CONCRETE PAVING SF ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑CLEARING/GRADING/FILL/EXCAVATE CY ❑CUT/BORE IN PAVEMENT(PARALLEL) LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: APPLICANT NAME:SNOHOMISH COUNTY PUD (DAVID CERDENOLA) APPLICANT MAILING ADDRESS: STREET PO BOX 1 107 CITY STATE ZIP APPLICANT PHONE:425-783-5107 APPLICANT EMAIL:DCCERDENOLLA@SNOPUD.COM PRIMARY CONTACT: ❑OWNER ❑APPLICANT ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE:425-783-5107 DAVID CERDENOLA CONTACT EMAIL:DCCERDENOLA@SNOPUD.COM ACKNOWLEDGEMENT.l have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must 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 authorized in writing from the Building Official before being authorized under any circumstance. I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made,and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# PW caner/Authorized Agent Signature Date (Revised 10/12/2015)