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47"7- Pt LIC WORKS PERMIT PLICATION <br /> 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:415 OLYMPIC BLVD <br /> IF APPLICABLE: O LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE: OSFR-DETACHED OSFR-ATTACHED I=DUPLEX OMULTI-FAMILY =COMMERCIAL <br /> CHANGE OF USE? = NO o YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? O NO O YES,TYPE SIZE <br /> SITE WORK/ RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: Restoration of a disturbed stream buffer area <br /> El 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 <br /> CONTACT INFORMATION <br /> OWNER NAME: BARTON KELVIN/PATTI <br /> OWNER MAILING ADDRESS: STREET 7691 FRANCIS LANE <br /> ciTy BLAINE STATE WA ZIP 98230 <br /> OWNER PHONE: 3609271112 (OWNER EMAIL: KELVIN@KRONTEL.COM <br /> APPLICANT NAME: BARTON KELVIN/PATTI <br /> APPLICANT MAILING ADDRESS: STREET 7691 FRANCIS LANE <br /> cm( BLAINE STATE WA ZIP 98230 <br /> APPLICANT PHONE: 3609271112 (APPLICANT EMAIL: KELVIN@KRONTEL.COM <br /> PRIMARY CONTACT: u OWNER O APPLICANT O 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 for which application is made, and I cgmply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> -61,0 7 k j r 9'/21!/8' City of Everett Official Use Only <br /> PERMIT# <br /> PW1710-025 <br /> Authorized Agent/Owner Date (Revised 10/12/2015) <br />