2106 CHESTNUT ST 2019-10-31 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 4trr (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I https://everettwa.gov/permits I PROJECT SITE INFORMATION --PROJECT ADDRESS: 2,1 0 6 Ch e__ -;-•(\v-k- sS `-ecA2 L.Vefe-1 W 9810 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) IF APPLICABLE: 0 FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# ` DESCRIPTION OF SITE WORK I RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: II ,FENCE IN ROW 1 1 FT IN HEIGHT STORMWATER DISCHARGES TO: ❑DRIVEWAY APRON/CURB CUT FT WIDE 0 Combined Sewer ❑ASPHALT/CONCRETE PAVING SF 0 Separated Storm Sewer ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF 0 Direct Discharge to Snohomish River or Puget Sound ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: 0 CLEARING/GRADING/FILL/EXCAVATE CY 0 MR2 Only 0 MR1-5 0 MR1-9 0 CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: 0 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF 0 POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: SF CONTACT INFORMATION__ -. ... . _ OWNER/APPLICANT NAME: A'T Ck U-\'‘ e_x v 2- ,,- ,• OWNER/APP. MAILING ADDRESS: STREET 2l I C)t C_V\ "1 rw k S"� 1/v CITY CQ- STATE r) ZIP 9 3 2_61 OWNER/APP. PHONE: OWNER/APP.EMAIL: `Required for Work in Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: I OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect,itEngineer, Etc.) CO ACT NAME: ECU CONTACT PHONE: '2.O(� 1 Sv HCl Com\ z- CONTACT EMAIL: acO1 CCS�,�9 C O 41 C' (vka t. c O r 1 ACKNOWLEDGEMENT*I have reviewed this application and confirm the information contained herein is true and correct. Work don6 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 Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is m-.-, -nd I c. .ly with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only f/ PERMIT# -- �i 01/2_9i1PW :90i- O(, Owner/Authorized Agent S =•ature Date (Revised 1/72019)