511 COLBY AVE 2019-10-31 - Laserfiche WebLink

P---CLIC WORKS PERMIT . 'PLICATION in CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE NFORMATION PROJECT ADDRESS: . 9_CI_fr� SITE WORK FOR PROJECT TYPE: $FR-DETACHED ❑i WNHOUSE ODUPLEX ❑AD-!5i LTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) 2.-4.-", *" & 1vo.\\elC, e ms..),30,,,, DESCRIPTION OF SITE WORK:1 RIGHT;OF-WAY:WORK . FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑ FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: ❑ DRIVEWAY APRON/CURB CUT FT WIDE 0 Combined Sewer iiikASPHALT/CONCRETE PAVING L,(Jt� 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: ❑ CLEARING/GRADING/FILL/EXCAVATE CY iziMR2 Only 0 MR1-5 0 MR1-9 ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: SF CONTACT INFORMATION. . . � C J OWNER/APPLICANT NAME: VCt � `` `� OWNER/APP. MAILING ADDRESS: STREET [ /L t .7. Y 1 e ' 1 STATE Z ) CITY ) � /� �� OWNER/APP. PHON4 . 4.I .. --. .,1(4-{p OWNER/APP EMAIL......,, ._..., ..... .__ ._.... . Y ,,.,... .._. *Required for Work in Public Right-of-Way CONTRACTOR NAME: ``, \Qp \) v c,<1— i � s- -2_, ? --- 2_(,(3,c , CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: - CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): �1)-)E 1 a x a 5535 EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑ OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: 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 Building Official before being authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only '' '''k ‘�I11 PERMIT# �D PW 1x109 - G -3 ner/Authorized gent-Sig re Date (Revised 4/15/2019)