1608 PUGET DR 2020-04-02 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION ''-' CITY OF EVERETT PERMIT SERVICES �. ,? 3200 CEDAR STREET, EVERETT, WA 98201 vitii (P)425-257-8810 I FAX 425 257 8857 (E) everetteps@everettwa.gov https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: i 6 0 ' PO4./�f 1)`t � SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU EMULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL 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: ❑FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: ❑DRIVEWAY APRON/CURB CUT FT WIDE 0 Combined Sewer ❑ASPHALT/CONCRETE PAVING SF 0 Separated Storm Sewer 0 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: 0 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: ,'G 7 6— SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: /C �S SF CONTACT INFORMATION ,.< . OWNER/APPLICANT NAME: 1 -, \( (4P r,..:41c, OWNER/APP.. MAILING ADDRESS: STREET I D c--� w✓A� f r-at- [7 zQ s--7 3- �pc cm, Ore ( ( STATE .� ZIP ! P "2 OWNER/APP. PHONE: OWNER/APP. EMAIL: G --tai 4••✓Vhe/Y.ck & fres,4.C O..t *Required for Work in Public Flight-of-Way CONTRACTOR NAME: 1 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT� NAME: CONTACT PHONE: 2,76- -SS'- /0 ire- -al( (1`o ri:e CONTACT EMAIL: Gov Pi 4 1� g A2S'/1 - CO-k. 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.l am 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 V;. PERMIT# PW .'''70 4- o Owner/Authorized A ent Signature Date (Revised 1/72019)