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PALIC WORKS PERMIT AWLICATION <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: 1031 SE Everett Mall Way <br />IF APPLICABLE: XI LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) REV1 #16-022 <br />SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI -FAMILY XCOMMERCIAL ❑INDUSTRIAL <br />CHANGE OF USE? ❑ NO X YES, FROM Office To Dental Office and possible retail/food tenant <br />NEW WATER / SEWER SERVICE NEEDED? X 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 />CO _., <br />❑ FENCE IN ROW <br />FT IN HEIGHT <br />❑ DRIVEWAY APRON / CURB CUT <br />FT WIDE <br />XI ASPHALT / CONCRETE PAVING 5,400 <br />SF <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY <br />LF <br />❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT <br />FT TOTAL HEIGHT <br />❑ CLEARING / GRADING / FILL / EXCAVATE <br />CY <br />❑ CUT/BORE IN PAVEMENT (PARALLEL) <br />LF <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) <br />LF <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 />ciTv Corona STATE CA zip 92880 <br />APPLICANT PHONE: 951-582-5745 <br />1APPLICANT EMAIL: Margetichj@pacden.com <br />PRIMARY CONTACT: ❑ OWNER XI 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.' 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. I am the owner, or 1 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 />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # <br />Pw02_-0C3 <br />(Revised 1011212015) <br />