5022 SEAHURST AVE 2020-05-20 - Laserfiche WebLink

PUELIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 477- (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE:INFORMATION:= • PROJECT ADDRESS: �()� ��y�/�� f� �tJZ�Et�f LUQ 9(3Zo 3 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX DADU ❑MULTI-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# I ESCRIPTION=OF.SITE W RK, R't,GHT.6041A' 1Y'.ORK . .....:. 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 01.. SPHALT/CONCRETE PAVING ,35O 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: I-0 rdCnY\ LUi1/Ir' Y1C�M OWNER/APP. MAILING ADDRESS: STREET 5(-)ZZ qIAUr k UL crn' N�� STATE JA ZIP 9g 276 � CCC OWNER/ PHONE 9S/ 5 / 5033 OWNER]APP AIL c or►il .....r, APP OWER .� w EM- *Required for Work in Public Right-of-Way ( J CONTRACTOR NAME: ejk.vlpp LG��(�(Y I SSS LC- CONTRACTOR CONTRACTOR ADDRESS: f STREET Z'I Zg (3((0* (� C� CITY CC�++id9f. I1 I;it l + _ STATE T‘ ZIP /(�fQr/�1- CONTRACTOR PHONE: 11ZS—6p8—O7 SrG CONTRACTOR EMAIL: 141,t►rpn - iAA y/1e(�cE t c.co VIA CONTRACTOR LICENSE#(REQUIRED): (t,1-{1A9 7 L �7 pe.../46. too j�,i�cl EVERETT BUSINESS LICENSE#(REQUIRED) PRIMARY CONTACT: �� m � �� a �� ❑OWNER /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. I 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 PERMIT# 33 7 PW 1103-oZ - Owner/Authorized •g S.nature Dat (Revised 1/72019)