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PUBLIC WORKS PERMIT APPLICATION <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: Multiple locations along Airport Road (See Attached) <br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> SITE WORK FOR PROJECT TYPE:❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY EICOMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? 0 NO 0 YES, FROM TO <br /> NEW WATER/SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE SIZE <br /> SITE WORK FRIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: Community Transit Swift II BRT - Construct Swift Bus Rapid Transit (BRT) <br /> Shelters and associated roadway and signal improvements along Airport Road. <br /> V FENCE IN ROW (See Attached) FT IN HEIGHT <br /> • DRIVEWAY APRON/CURB CUT (See Attached) FT WIDE <br /> ASPHALT/CONCRETE PAVING (See Attached) SF <br /> O RETAINING WALL/ROCKERY IN RIGHT-OF-WAY (See Attached) LF <br /> ❑ RETAINING WALL /ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br /> CLEARING/GRADING/FILL/EXCAVATE (See Attached) CY <br /> CUT/BORE IN PAVEMENT(PARALLEL) (See Attached) LF <br /> 0 CUT/BORE IN PAVEMENT(NON-PARALLEL) (See Attached) LF <br /> CONTACT INFORMATION <br /> OWNER NAME: Community Transit <br /> OWNER MAILING ADDRESS: STREET 7100 Hardeson Road <br /> cin Everett STATE WA ZIP 98203 <br /> OWNER PHONE: 425-348-2367 OWNER EMAIL: todd.jacobs@commtrans.org <br /> APPLICANT NAME: Todd Jacobs, Community Transit <br /> APPLICANT MAILING ADDRESS: STREET 7100 Hardeson Road <br /> ci-rr Everrett STATE WA ziP 98203 <br /> APPLICANT PHONE: 425-348-2367 APPLICANT EMAIL: todd.jacobs@commtrans.org <br /> PRIMARY CONTACT: ❑ OWNER 0 APPLICANT El OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: 425-739-4242 <br /> Windi Shapley CONTACT EMAIL: windi.shapley@otak.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. 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 /> rzs2-0f6 PW /( 1Z - 015 <br /> OwnerfAuthdd-:, •gent Signature \( rn!r)1 54-k'1MLE L, Date (Revised 9/23/2016) <br />