2125 COLBY AVE 2020-02-06 - Laserfiche WebLink

CLIC WORKS PERMIT Ii PLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 0114ETT (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJJEcT SITE=INFORMATION_.. ., . . . PROJECT ADDRESS: V `G i c'—�` e 2y 1AJ Gym SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED TOWNHOUSE ❑DUPLEX DADU DMULTI-FAMILY ❑COMMERCIAL 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# DESCRIPTION'OF,..SITE WORK i RIGHTOF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: 11FENCE IN ROW 2 FT IN HEIGHT STORMWATER DISCHARGES TO: ❑DRIVEWAY APRON/CURB CUT FT WIDE ❑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 ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: SF CONTACT INFORMATION OWNER/APPLICANT NAME: PC.cA„. OWNER/APP. MAILING ADDRESS: STREET Q C '3 C. t �s -' '1 CITY V'1 STATE ZIP &2� OWNER/APP. PHONE: 12-s .S OZk-k.L. OWNER/APP.EMAIL: l 54741 tom+4 j `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 �. . .� .�„._ . ..� . _...._ 4. CONTACT: 0 OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: Li Z _S-70?�l.!2 L 6,5 kv,J C�`�G+� 1✓ CONTACT EMAIL: Ct✓e- p'i£c%/•.Ci �r L U ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contai d herein is tide and correctiWork 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 writin. rom =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 ..rk .r ich application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only /I PERMIT# 114 bt PW 19PV- it7 Owner/Aut ori •d •.:nt Signature Date (Revised 1/72019)