5108 ALTA DR 2020-05-04 - Laserfiche WebLink

CLIC WORKS PERMIT 'PLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 https://everettwa.gov/permits PROJECT SITE INFORMATION . . PROJECT ADDRESS: S)9 g 4-C.& CZ,7 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE 0 DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL 0 INDUSTRIAL IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) DESCRIPTION OF SITE WORK:VRIGHT OF NAY:WC RK . FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: .ENCE IN ROW 3 12 !k 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 ❑ MR2 Only ❑ MR1-5 ❑ 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: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: SF GO.NTACT I IFQRN ATION... OWNER/APPLICANT NAME: / c J-®j'\ 6 A-"I' OWNER/APP. MAILING ADDRESS: STREET 57 A-vi-c. (fL /� CITY �'l/e P 4 STATE ,l j ZIP S R 3 OWNER/APP.PHONE: 906 113 ' OWNER/APPEMAIL: -OLSD ((l� 'k u *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 CONTACT: ICOWNER /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. l am the owner,or l am authorized by the owner of this property to perform the work for which application is made,and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# .�r4° ©g /o?,C id 0/ PW v9o9-080 Owner/Authored Agent Signature Date (Revised 4/15/2019)