6001 EVERGREEN WAY 2018-05-15 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION � CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PRo.IECT ADDRESS: 6001 EVERGREEN WAY/CITY OF EVERETT RESERVOIR#3 FIBER IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY �COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? IgI NO ❑YES, FROM TO NEW WATER/SEWER SERVICE NEEDED? 6�I NO ❑YES,TYPE SIZE SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: INSTALL CITY OF EVERETT FIBER OPTIC CABLE FROM THE CITY OF EVERETT RESERVOIR#3 LOCATED AT 6001 EVERGREEN WAY TO AN EXISTING CABLE VAULT LOCATED AT THE SOUTHWEST CORNER OF EVERGREEN WAY AND PECKS ROAD. THE FIBER CABLE WILL BE INSTALLED IN EXISTING OVERHEAD AND UNDERGROUND PATHWAY. ❑FENCE IN ROW 0 FT IN HEIGHT ❑DRIVEWAY APRON/CURB CUT 0 FT WIDE F ❑ASPHALT!CONCRETE PAVING 0 SF '.�1.� 1 L L ��l'. �Q�Vi C{ G��d r�k ic U�v�#- � ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY � LF � �� (� --.�G(Y), ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT 0 FT TOTAL HEIGHT ❑CLEARING/GRADING/FILL/EXCAVATE � CY — �� .� ��+�� e�;� ( ,r ❑CUT/BORE IN PAVEMENT(PARALLEL) � LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) � LF CONTACT INFORMATION OWNER NAME: CITY OF EVERETT/INFORMATION TECHNOLOGY OWNER MAILING ADDRESS: sTReer 2930 WETMORE AVE SUITE 6A aTv EVERETT sTnTe WA ziP 98201 OWNER PHONE: (425)257-8663 OWNER EMAIL: KWALSER CI.EVERETT.WA.US APPLICANT NAME: MILNE ELECTRIC APPLICANT MAILING ADDRESS: sTReer 14582 172ND DRIVE SE cirr MONROE sTare WA ziP 98272 APPLICANT PHONE: 360 863-9617 EXT 229 APPLICANT EMAIL: GEORGE.HATLAND@MILNEELECTRIC.COM PRIMARY CONTACT: ❑OWNER �APPLICANT ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: (360)863-9617 EXT 229 GEORGE HATLAND CONTACT EMAIL: GEORGE.HATLAND@MILNEELECTRIC.COM ACKNOWLEDGEMENT:I 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 loca/law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authonzed in writing from the Building Official before being authorized under any circumstance. 1 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. City of Everett OKicial Use Onl y � PERMIT# 1�,'s: .' .:�i�/,�'-� �-�Z g+l`+'`�� :l'.�';��.'r � � V V /��V/ (�' /L� � i Owner/Authorized Agent Signature Date (Revised 10/12/2015J