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, PUBLIC WORKS PERMIT APPLICATION
<br /> . 'NitiiiWCITY 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
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<br /> PROJECT ADDRESS:5427 BROADWAY
<br /> IF APPLICABLE: O LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) .
<br /> SITE WORK FOR PROJECT TYPE: =SFR-DETACHED =SFR-ATTACHED =DUPLEX =MULTI-FAMILY =COMMERCIAL
<br /> CHANGE OF USE? O NO = YES, FROM TO
<br /> NEW WATER/SEWER SERVICE NEEDED? O NO O YES,TYPE SIZE
<br /> ......� „a . -_ ._ �;3 , cm,r.,,.. ,.1a ',,,,, _ 4 x,,. . o.- at ..a: '3,k., ? ft
<br /> DESCRIPTION OF WORK: 280332 COMCAST/PACIFIC CABLE
<br /> INSTALL CATV SERVICE LINE. BORE A TOTAL OF 16FT HARD SURFACE CROSSING SHARED DRIVEWAY OF
<br /> 5427/5429/5431
<br /> = CUT/BORE IN PAVEMENT(PARALLEL) LF
<br /> = CUT/BORE IN PAVEMENT(NON-PARALLEL) LF
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<br /> OWNER NAME: GIO INC .
<br /> OWNER MAILING ADDRESS: STREET 125 130TH ST SE STE 202
<br /> cry EVERETT STATE WA ZIP 98208
<br /> OWNER PHONE 'OWNER EMAIL:
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<br /> APPLICANT NAME: Breanna Swift
<br /> APPLICANT MAILING ADDRESS: STREET PO Box 573
<br /> cir' Woodinville STATE WA ZIP 980129801
<br /> APPLICANT PHONE: 4253487735 (APPLICANT EMAIL: breanna@paccab.com
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<br /> PRIMARY CONTACT: = OWNER =APPLICANT = OTHER(Architect, Engineer, Etc.)
<br /> CONTACT NAME: [ContactName] CONTACT PHONE:[ContactPhone]
<br /> CONTACT EMAIL: [ContactEmail]
<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 /> PERMIT#
<br /> PW1804-015
<br /> ETRAKIT APPLICATION RECEIVED 4/6/2018 (Revised 3/30/2018)
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