1031 SE EVERETT MALL WAY MODERN DENTISTRY 2022-03-07

PALIC WORKS PERMIT AWLICATION 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: 1031 SE Everett Mall Way IF APPLICABLE: XI LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) REV1 #16-022 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI -FAMILY XCOMMERCIAL ❑INDUSTRIAL CHANGE OF USE? ❑ NO X YES, FROM Office To Dental Office and possible retail/food tenant NEW WATER / SEWER SERVICE NEEDED? X NO ❑ YES, TYPE SIZE SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: New parking lot in ROW along Everett Mall Way CO _., ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON / CURB CUT FT WIDE XI ASPHALT / CONCRETE PAVING 5,400 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: Everett Covenant Group OWNER MAILING ADDRESS: STREET 17000 Red Hill Ave CITY Irvine STATE CA ZIP 92614 OWNER PHONE: OWNER EMAIL: APPLICANT NAME: Covenant Group / Julie A. Margetich APPLICANT MAILING ADDRESS: STREET 2044 California Ave ciTv Corona STATE CA zip 92880 APPLICANT PHONE: 951-582-5745 1APPLICANT EMAIL: Margetichj@pacden.com PRIMARY CONTACT: ❑ OWNER XI APPLICANT ❑ OTHER (Architect, Engineer. Etc.) CONTACT NAME: Julie A. Margetich CONTACT PHONE: 951-582-5745 CONTACT EMAIL: Margetichj@pacden.com ACKNOWLEDGEMENT.' 1 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. Owner/Authorized Agent Signature Date City of Everett Official Use Only PERMIT # Pw02_-0C3 (Revised 1011212015)