408 109TH PL SE 2020-07-01 - Laserfiche WebLink

NNE PL 'LIC WORKS PERMITIMPLICATION ELI CITY OF EVERETT PERMIT SE ' iUES EVERETT(P) 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: tic F. loci lk Pt SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADO ❑MULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) `:,DESCRIPTION OF SITE=WORK.l''RIGHT;OF-WAY:.WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: FENCE IN ROW r FT IN HEIGHT STORMWATER DISCHARGES TO: O 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 0 MR2 Only 0 MRI-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 GONTAC .11IOR1111A' ION....... OWNER/APPLICANT NAME: F( Az:A A-I OWNER/APP. MAILING ADDRESS: STREET 0 /o "k pt , sr CITY L'04— STATE 4 ZIP /47'(C.)V OWNER/APP PHONE EZS ��^QS© OWNER/APP EMAIL: W ?SCO kc')rAck i S t _._,. '-iYc.•,...,. »„.,a�. _'.,_*s r..k,,�. �s. �...x, .� w„ao,.,. *Required for Work in Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET • 1 CITY t .-r !ST.I ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: 4 $y `7'7*".1 CONTRACTOR LICENSE#(REQUIRED): • EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER /APPLICANT 0 CONTRACTOR '0 OTHER(Architect "Engineer, Etc.) CONTACT NAME: CONTACT PHONEt ` ' 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.1 am the owner,or lam 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# _ - C- . 1E4, 2017 PW / o - 3 Owner/Authorized Agent Signature Date (Revised 4/15/2019)