8525 EVERGREEN WAY 2019-02-05 - Laserfiche WebLink

• 14:77. PUBLIC WORKS PERMIT APPLICATION .f CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits .', P:ROJECT SITE INFORMATIIO,Nk . ..,,,. PROJECT ADDRESS: 8525 EVERGREEN WAY IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY 121COMMERCIAL El INDUSTRIAL CHANGE OF USE? 121 NO ❑YES, FROM TO -- NEW WATER/SEWER SERVICE NEEDED? 121 NO 0 YES,TYPE SIZE SITE WORK%1It1iG IT-OF';WAIf *707,041000:011:0170:0:07.404, N .. DESCRIPTION OF WORK: APS to pothole existing underground utilities to determine the depth and location for design purposes. 4 pothole locations total. o FENCE IN ROW FT IN HEIGHT ❑DRIVEWAY APRON/CURB CUT FT WIDE I—' FP s "s, ❑ASPHALT/CONCRETE PAVING SF 0 RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF L."a" i' " • � ` L x ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ?--' ❑CLEARING/GRADING/FILL/EXCAVATE CY L° 4 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF CONTACT �NFOlt 4 R OWNER NAME: City of Everett OWNER MAILING ADDRESS: STREET 3200 Cedar St. CITY Everett STATE WA ZIP 98201 OWNER PHONE: 425-257-8810 OWNER EMAIL:everetteps@everettwa.gov APPLICANT NAME: John Gardin APPLICANT MAILING ADDRESS: STREET 43530 SE North Bend Way CITY North Bend STATE WA ZIP 98045 APPLICANT PHONE:425-864-5547 APPLICANT EMAIL:johng@apslocates.com PRIMARY CONTACT: 0 OWNER pi APPLICANT 0 OTHER(Architect, Engineer,Etc.) CONTACT NAME: CONTACT PHONE: 425-864-5547 John Gardin CONTACT EMAIL: johng@apSlocateS.Corn 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 local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Build' g•fcial before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the'work .r which appli'.do is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 1 PERMIT# PW /t3o1 - Od i Owner/Authorized Agen Signe Date (Revised 9/23/2016)