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/1/41j -Hi1P-, .,---." ' <br /> FBLIC WORKS PERMIT APPLICATION <br /> ....- l- 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 /> PROJECT ADDRESS: 1602 Hewitt Ave <br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE APP,SS,ETC.) <br /> SITE WORK FOR PROJECT TYPE:DSFR-DETACHED DSFR-ATTACHED DDUPLEX OMULTI-FAMILY OCOMMERCIAL El INDUSTRIAL <br /> CHANGE OF USE? al NO 0 YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? D NO 0 YES,TYPE SIZE <br /> SITE WORK/RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: Saw cut concrete to access underground conduit, in street on Hewitt Ave. <br /> D FENCE IN ROW FT IN HEIGHT <br /> D DRIVEWAY APRON/CURB CUT FT WIDE <br /> D ASPHALT/CONCRETE PAVING SF <br /> D RETAINING WALL!ROCKERY IN RIGHT-OF-WAY LF <br /> D RETAINING WALL!ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> D CLEARING/GRADING/FILL!EXCAVATE CY <br /> D CUT/BORE IN PAVEMENT(PARALLEL) 16 s[0 If_ (4 X¢) LF <br /> D CUT/BORE IN PAVEMENT(NON-PARALLEL) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: Barry Gifford <br /> OWNER MAILING ADDRESS: STREET 14831 SE 324 St <br /> c,Ty Auburn STATE WA. zp 98092 <br /> OWNER PHONE: 253-833-8088 OWNER EMAIL: mpres8088@aol.com <br /> APPLICANT NAME: Presco Telecommunications Inc. <br /> APPLICANT MAILING ADDRESS: STREET 14831 SE 324th St. <br /> cm Auburn STATE WA. zip 98092 <br /> APPLICANT PHONE: 253-833-8088 'APPLICANT EMAIL: mpres8088@aol.com <br /> PRIMARY CONTACT: 0 OWNER is APPLICANT Cl OTHER(Architect,Engineer,Etc.) <br /> CONTACT NAME: CONTACT PHONE:(206-963-6662 <br /> Barry Gifford CONTACT EMAIL: barry.g@prescotelecom.us <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.lam the owner,or I am authorized by the owner of this property to <br /> perform the work for which application is made,and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 4 . 7 <br /> i6 zoi7 PWl 1 0 CO- <br /> Owner/Authoriz Agent Sig tur Date (Revised 9/23/2016) <br />