1932 VIRGINIA AVE 2019-11-07 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 4rETT (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: / ?JZ /eC-i/t//4 A Ue-- SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED DTOWNHOUSE ❑DUPLEX DADU ❑MULTI-FAMILY DCOMMERCIAL DINDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# DESCRIPTIONOF SITE WORK E:RIGHT._OF.WAY WORK:: FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑FENCE IN ROW `Y �/ 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: ❑CLEARING/GRADING/FILL/EXCAVATE CY 0 MR2 Only 0 MRI-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 OWNER/APPLICANT NAME: /72 v ,7C ©U 6 )e OWNER/APP. MAILING ADDRESS: STREET / 9 3 Z L//4'6-4 "'� �j STATE L ,Z10'//'`/(-->11/2--7, `' ZIP�fI <</ OWNER/APP. PHONE: 7,Z'S 30 l X60 q OWNER/APP. EMAIL: Z 9//'`/>1v�Lc3 / XU/V2 42-- C. *Required for Work in Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: `"/ 3TREET 26//0/W7— ZS— o�S 5-37 0 CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED) ,JEVERETT BUSINESS LICENSE#(REQUIRED) PRIMARY CONTACT: 0 OWNER / .� APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, EtC)°' CONTACT NAME:` ` CONTACT PHONE: ✓1'/ '_/ 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 w ich application is made,and I compl ith the State Contractors Law 18.27 RCW and 296.200A WAC. / - .0000,40 / City of Everett Official Use Only PERMIT# ' y pw ig2to6-- ©-73 0• er/Authori,.'•gent Signatu Date (Revised 1/72019)