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��J�LIC WORKS PERMIT PPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 208 Lamar Drive <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? I,ZI NO ❑YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? �NO ❑YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: Replace water main in Lamar Drive. Restoration of impacted area will include full width overiay of Lamar Drive. <br /> ❑FENCE IN ROW FT IN HEIGHT <br /> ❑DRIVEWAY APRON/CURB CUT FT WIDE <br /> �(]ASPHALT/CONCRETE PAVING 700 (City of Everett impacted area) SF <br /> ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> ❑CLEARING/GRADING/FILL/EXCAVATE CY <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> owrveR N,ame: Mukilteo Water and Wastewater District <br /> OWNER MAILING ADDRESS: sTReer �824 Mukilteo Speedway <br /> �iTM Mukilteo STATE WA zia 98275 <br /> owNER PHotve: 425-355-3355 OWNER EMAIL: rickm@mukilteowwd.org <br /> APPLICANT NAME: Sa171@ <br /> APPLICANT MAILING ADDRESS: sTReer <br /> CITY STATE ZIP <br /> APPLICANT PHONE: APPLICANT EMAIL: <br /> PRIMARY CONTACT: �7 OWNER ❑APPLICANT ❑OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: 425-355-3355 <br /> Rick Matthews CONTACT EMAIL: rickm@mukilteowwd.Ofg <br /> ACKNOWLEDGEMENT.•1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to lhis permit must <br /> comply with current federal, state,and local law. The granting of a permit only authonzes 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 l 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 /> City of Evereft OHicia!Use Only <br /> PERMIT# <br /> < / PW1 t�i— c�� � <br /> . _� <br /> `� �--L— L G,_' `� � _ I`'` `l� <br /> Owner/�luthorized Agent Signature Date (Revised 9P23/2016) <br />