3320 HILL AVE 2020-03-06 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION �0►' CITY OF EVERETT PERMIT SERVICES ,/ 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION' . PROJECT ADDRESS: SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED TOWNHOUSE ❑DUPLEX ❑ADU OMULTI-FAMILY ❑COMMERCIAL INDUSTRIAL 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`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 ,ASPHALT/CONCRETE PAVING /�7`7 d 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 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 OWNER/APPLICANT NAME: /-:-/• // L- OWNER/APP. MAILING ADDRESS: STREET Z.'? // CITY 74/ STATE ZIP OWNER/APP. PHONE WS---Z/0-7 247 OWNER/APP EMAIL: 4 "' 665 "Required for Work in Public Right-of-Way • Gc h CONTRACTOR NAME: Qom/ CONTRACTOR ADDRESS: STREET /2 ---"&.,.G 3j 7' / CITY f`'��/l . STATE (/C�� ZIP / 2.Z CONTRACTOR PHONE: -/Z5—25-2—/G/O CONTRACTOR EMAIL: ,2 i -4.ti �J /Ja /.tom, , G< Z. ERETT SS CONTRACTOR PRIMARY CONTACTNSE#(R INNER /A�CANT c�NTRACTO� OTHER VArch(A rchitect, Engineer, EEtc.) SE#(REQUIRED) //7 5 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.I am the owner,or 1 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 PERMIT# r / PW(` 06-© 3 Owner/Authorized Agent Signature / Dom' (Revised 1/72019)