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147 F- LIC WORKS PERMIT ?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 www.everettwa.gov/permits <br /> 78e) PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: - 19TH DR SE EVERETT 98204 LOT 2.6 <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ®SFR-ATTACHED El DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? IJ NO 0 YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED 0 NO J 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 /> O 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 /> OWNER NAME:ALPINE HEIGHTS LLC <br /> OWNER MAILING ADDRESS: sTREET120 SW EVERETT MALL WAY SUITE 100 <br /> cin' 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: ❑ OWNER $7 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.I 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 /> PER`MIIT#I ( n <br /> —3-15-16 y J l fO PW <br /> V/ <br /> Owner/Authorized Agent Signature Date <br /> (Revised 10/12/2015) <br />