901 52ND ST SE 2020-06-18 - Laserfiche WebLink

P J3LIC WORKS PERMIT Arr-'LICATION 14tEn- 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 1 https://everettwa.gov/permits PROJECT SITE,INFORMATION PROJECT ADDRESS: ' SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED TOWNHOUSE ❑DUPLEX DADU ❑MULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL 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 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 ❑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 0 CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF 0 POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: SF CO NTACT INFORMATION OWNER/APPLICANT NAME: _t7"u // OWNER/APP. MAILING ADDRESS: STREET " J /� J, 62, L �7 (yti CITY ] ,r/I ,ice/ �/ i I S EZIP z- OWNER/APP.PHONE: OWNER/APP.EMAIL: G *Required for Work in Public Right-of-Way CONTRACTOR NAME: %2C'/t CONTRACTOR ADDRESS: 1/'/ STREET ,5-2 2 CITY /4/7e STATE /' ZIP�l�" CONTRACTOR PHONE: J(DC) 9 `17 lr( It CONTRACTOR EMAIL: 4.647j--7:1 /-70, 7 y`4-1•OC)• CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 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.lam 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# Pw /fc'`7- c3S— • ne" th "r gent Signature Date (Revised 1/72019)