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00014111,- PUBLIC WORKS PERMIT APPLICATION
<br /> '!il►'"� CITY OF EVERETT PERMIT SERVICES
<br /> •
<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: 10627 19TH AVE SE
<br /> IF APPLICABLE: o LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.)
<br /> SITE WORK FOR PROJECT TYPE: OSFR-DETACHED OSFR-ATTACHED =DUPLEX O MULTI-FAMILY O COMMERCIAL
<br /> CHANGE OF USE? O NO O YES, FROM TO
<br /> NEW WATER/SEWER SERVICE NEEDED? O NO O YES,TYPE SIZE
<br /> DESCRIPTION OF WORK: SITE WORK FOR NEW COMMERCIAL BLDG (DENTAL OFFICE)
<br /> O FENCE IN ROW FT IN HEIGHT
<br /> O DRIVEWAY APRON/CURB CUT FT WIDE
<br /> =ASPHALT/CONCRETE PAVING SF
<br /> O RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF
<br /> O RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT
<br /> O CLEARING/GRADING/FILL/EXCAVATE CY
<br /> O CUT/BORE IN PAVEMENT(PARALLEL) _ LF
<br /> O CUT/BORE IN PAVEMENT(NON-PARALLEL) LF
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<br /> OWNER NAME: EPC HOLDINGS 908 LLC
<br /> OWNER MAILING ADDRESS: STREET 2001 WESTERN AVE SUITE 330
<br /> cii-Y SEATTLE STATE WA ZIP 98121
<br /> OWNER PHONE: 'OWNER EMAIL:
<br /> •
<br /> APPLICANT NAME: GABBERT ARCHITECTS
<br /> APPLICANT MAILING ADDRESS: STREET 20011 BALLINGER WAY NE
<br /> crry SHORELINE STATE WA ZIP 98155
<br /> APPLICANT PHONE: 063673600 ..
<br /> •• APPLICANT EMAIL: simon.s@gabbertarchitects.com
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<br /> PRIMARY CONTACT: O OWNER O APPLICANT O OTHER(Architect, Engineer, Etc.)
<br /> CONTACT NAME:SIMON SIMON GABBERT CONTACT PHONE:063673600 •
<br /> ARCHITECTS
<br /> CONTACT EMAIL: simon.s@gabbertarchitects.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.lam 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 /> PW1710-032
<br /> Authorized Agent/Owner Date (Revised 10/12/2015)
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