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� � <br /> PUBLIC WORKS PERIVIIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, E\/ERETT, WA 98201 <br /> (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@eve�rettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE IIdFORM,AT101�! <br /> PROJECT ADDRESS: 'I O42rJ Z9tI1 AV@. SE, Everett WA 98208 <br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:�SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? �NO ❑YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? �NO ❑ YES,TYPE SIZE <br /> SITE WORK / RIGHT-OF-WAY APPLICA'TION INFORMATION <br /> oEscRiPTiorv oF woRK: Remove and replace damaged sectian of driveway apron on HOA common <br /> property that leads into a private property driveway. Attached is a measured drawing <br /> (DrivewayCut10425.pdf) of the driveway apron repair ��rea. <br /> ❑FENCE IN ROW FT IN HEIGHT <br /> -,,1��. . :: ;-;,..,. <br /> � DRIVEWAYAPRON/CURB CUT Remove& Replace 18.3 sqft. FT w�oE ,,,� ,� ;� %.''��=";�'.�,_ <br /> � j...��'� �' 'S:/ �.-.`r ' "O <br /> ❑ASPHALT/CONCRETE PAVING gF n � ' � �'�=��I i t <br /> ; � <br /> ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY �F '�.? l ,G`��J O,�j �y�i' �,( <br /> ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT �� i,�, <br /> ❑CLEARING/GRADING/FILL/EXCAVATE Cy Q� ���RE T) <br /> �'�rms� Ser�vi��, <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: CaSCad2 HI hlands Homeowners Association <br /> OWNER MAILING ADDRESS: sTREEr 11014 19th Ave. SE, Suite 8, PMB#20�� <br /> �,n Everett STATE WA Z,P 98208 <br /> OWNER PHONE: NO HOA PIlOII@ OWNER EMAIL:treasurer@chhoa.org <br /> APPLICANT NAME: WaItE.'f WI11t@ <br /> APPLICANT MAILING ADDRESS: srReer 2729 104th Place SE <br /> arr Everett STATE WA ziP 98208 <br /> APPLICANT PHONE:425-379-0929 APPLICANT EMAIL:treasurer@chhoa.org <br /> PRIMARY CONTACT: ❑OWNER �7 APPLICANT ❑OTHER(Architect, Enginee�r, Etc.) <br /> CONTACT NAME: CONTACT PHONE: 425-379-0929 <br /> Walter White CONTACT EMAIL: tfeaSlUC2f chhoa.or <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct. Wo�k done pursuant to this permit must <br /> comply with current federal, state, and local/aw. The granting of a permit on/y authorizes approved work and no deviations therefrom. Deviations must first be <br /> aufhorized in writing from the Building Official before being authorized under any circumstance. 1 am the owner,or/am authorized by the owner of this property to <br /> perform the work for which application is made, and/comp/y with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use On/y <br /> PERMIT# <br /> �,��c�-�7 PW /�D� �2... <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016J <br />