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04177 CLIC WORKS PERMI PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> �8 0 <br /> PROJECT ADDRESS: 4-84+2- 19TH DR SE EVERETT 98204 LOT 2010 2 / <br /> IF APPLICABLE 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED MSFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? El NO 0 YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED 0 NO 7 YES TYPE 6 INCH SIDE SEWER SIZE 1 INCH METER <br /> SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: <br /> ❑ FENCE IN ROW FT IN HEIGHT <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE <br /> 0 ASPHALT/CONCRETE PAVING SF <br /> 0 RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> 0 CLEARING/GRADING/FILL/EXCAVATE CY <br /> ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME:ALPINE HEIGHTS LLC <br /> OWNER MAILING ADDRESS: sTREET120 SW EVERETT MALL WAY SUITE 100 <br /> cnv EVERETT STATE WA ZIP 98204 <br /> OWNER PHONE: 360-953-2800 OWNER EMAIL: WWW.SEAPACHOMES.COM <br /> APPLICANT NAME:SEA PAC HOMES <br /> APPLICANT MAILING ADDRESS: STREET 120 SW EVERETT MALL WAY SUITE 100 <br /> cm, EVERETT STATE WA ZIP 98204 <br /> APPLICANT PHONE:360-953-2800 APPLICANT EMAIL: WWW.SEAPACHOMES.COM <br /> PRIMARY CONTACT: 0 OWNER $]APPLICANT 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME:STEVE SNYDER CONTACT PHONE: 425-319-0122 <br /> CONTACT EMAIL: STEVE.S@SEAPACHOMES.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 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.l 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 /> PERMIIT,# <br /> .3 1� 16 - ---,''C' 1 PEV V l a oLi ✓3 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />