2000 TOWER ST INDEX HALL 2020-06-05

P1ICLIC WORKS PERMIT ft 7PLICATION CITY OF EVERETT PERMIT SEIiV7tES EVERETT(P) 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2000 /QWe/ 504 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED DTOWNHOUSE ❑DUPLEX DADU ❑MULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) DESCRIPTION:OF SITE WORK l RIGHT OF-WAY WNORK 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 0 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 0 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 // /rAvi :GtrN 'ACT.I IFORIVIATION.. OWNER/APPLICANT NAME: 6 c-vGG OWNER/APP. MAILING ADDRESS: STREET )..OJjj 7yL/ SI CITY Even STATE 41,1 zip/G(YD.1„2_ OWNER/APP. PHONE: OWNER/APP. EMAIL: "Required for Work in Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET !O 2 I/ f 7% 'Vh�� r CITY 7110 { STATE II.," ZIP !o�j.�v CONTRACTOR PHONE: 206 797 77f CONTRACTOR EMAIL: Q y-P?g<c►/S�.hd/ /'GG� • Gorr? CONTRACTOR LICENSE#(REQUIRED) L 8GC�644-8" 'J//(s !VERETT BUSINESS LICENSE#(REQUIRED) 60;0 7/ PRIMARY CONTACT: 0 OWNER /APPLICANT *CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT N M' : CONTACT PHONE: /A,/ L.G/fl�l�I 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# PWi�O$ -010 Owner/Authorized Agent Signature Date (Revised 4/15/2019)