Laserfiche WebLink
• <br />• <br />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 ( (E) everetteps@everettwa.gov ) www.everettwa.gov/permits <br />PROJECT SITE:INFORMATION, <br />PROJECT ADDRESS: 1031 SE Everett Mall Way <br />IF APPLICABLE: DO LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) REV1#16-022 <br />SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI -FAMILY COMMERCIAL ❑INDUSTRIAL <br />CHANGE OF USE? ❑ NO M YES, FROM Office TO Dental Office and possible retail/food tenant <br />NEW WATER / SEWER SERVICE NEEDED? NO ❑ YES, TYPE SIZE <br />= SITE WORK,/ RIGHT-OF-WAY APPLICATION INFORMATION <br />DESCRIPTION OF WORK: New parking lot in ROW along <br />Everett Mall Way <br />❑ FENCE IN ROW <br />❑ DRIVEWAY APRON / CURB CUT <br />FT IN HEIGHT <br />FT WIDE <br />L <br />ASPHALT / CONCRETE PAVING 5400 <br />SF II�� <br />1' ���� <br />C �, <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY <br />LF <br />ElRETAINING WALL / ROCKERY OVER 4FT IN HEIGHT <br />ED <br />FT TOTAL IGHTjA:J�l Do <br />at 5:08:13 AM, 311512017 <br />❑ CLEARING / GRADING / FILL / EXCAVATE <br />CY 1) Time restrictions: Must be off the <br />El CUT/BORE IN PAVEMENT (PARALLEL) <br />roadway between 14:00 - 18:00. <br />LF <br />2) As per TCP provided, City of <br />/ <br />1/ <br />ICE <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) <br />LF Everett 701 D and MUTCD <br />r 7 <br />standards as applicable. <br />1 <br />CONTACT INFORMATION <br />OWNER NAME: Everett Covenant Group <br />OWNER MAILING ADDRESS: STREET 17000 Red Hill Ave <br />CITY Irvine STATE CA ZIP 92614 <br />OWNER PHONE: <br />OWNER EMAIL: <br />APPLICANT NAME: Covenant Group / Julie A. Margetich <br />APPLICANT MAILING ADDRESS: STREET 2044 California Ave <br />cnY Corona STATE CA zip 92880 <br />APPLICANT PHONE: 951-582-5745 <br />1APPLICANT EMAIL: Margetichj@pacden.com <br />PRIMARY CONTACT: ❑ OWNER) APPLICANT ❑ OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: <br />Julie A. Margetich <br />CONTACT PHONE: 951-582-5745 <br />CONTACT EMAIL: Margetichj@pacden.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 taw. 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 />- ' PWtK�-e2--oo3 <br />Owner/Authorized Agent Signature Date (Revised 1011212015) <br />