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• <br /> PUBLIC WORKS PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 E(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 4730 COLBY AVENUE <br /> IF APPUCABLE: in LAND USE PROJECT#(SEPA,PRE-APP,SS,ETC.)SPU#16.009 <br /> SITE WORK FOR PROJECT TYPE:OSFR-DETACHED OSFR-ATTACHED ODUPLEX OMULTI-FAMILY ®COMMERCIAL OINDUSTRIAL <br /> CHANGE OF USE? El NO 0 YES, FROM TO <br /> NEW WATER I SEWER SERVICE NEEDED? 0 NO 0 YES,TYPE DOMESTIC WATER,FIRE WATER.SEWER SIZE "OOI WATER r FIREWATER.r SIDE SEWER <br /> SITE WORK 1 RIGHT-OF-WAY APPLICATION INFORMATION <br /> DESCRIPTION OF WORK: New YMCA community facility that will provide a broad range of activities for health, <br /> fitness, and wellness programs. Facility will include a swimming pool, gymnasium, exercise room,and other facilities. <br /> ❑FENCE IN ROW 0 FT IN HEIGHT <br /> 0 DRIVEWAY APRON/CURB CUT 1 @ 26'WIDE/1 ©30'WIDE(2 TOTAL)Fr WIDE <br /> J ASPHALT!CONCRETE PAVING 111,000 SF <br /> O RETAINING WALL!ROCKERY IN RIGHT-OF-WAY n/a LF <br /> O RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT n/a FT TOTAL HEIGHT <br /> !a CLEARING/GRADING!FILL 1 EXCAVATE 20,000 CUT/20,100 FILL CY <br /> Q1 CUT/BORE IN PAVEMENT(PARALLEL) 1300 LF <br /> p CUT/BORE IN PAVEMENT(NON-PARALLEL) 50 LF <br /> CONTACT INFORMATION <br /> OWNER NAME: YMCA of Snohomish County-Scott Washburn <br /> OWNER MAILING ADDRESS: smE r 272o ROCKEFELLER AVENUE <br /> an. EVERETT STATE WA zp 98201 <br /> OWNER PHONE: 425.374.5709 OWNER EMAIL: SWashbum@ymCa-snoco.org <br /> APPLICANT NAME: BCRA-JUSTIN GOROCH,PE <br /> APPLICANT MAILING ADDRESS: sTmE.Er 414 STEWART STREET,SUITE 200 <br /> cm• SEATTLE STATE WA zip 98101 <br /> APPUCANT PHONE:253.627.4367 .,APPLICANT EMAIL:lgoroch©bcradesign.cam <br /> PRIMARY CONTACT: IA OWNER la APPLICANT 0 OTHER(Architect,Engineer,Etc.) <br /> CONTACT NAME: CONTACT PHONE: 253.6274367 <br /> JUSTIN GOROCH CONTACT EMAIL: jgoroch@bcradesign.com <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained heroin is tare and correct.Work done pursuant to this permit must <br /> comply with current federal,state.end local law The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be <br /> authorized in writing from the Building Official before being authorized under any circumstance.i am the owner,or 1 em authorized by the owner of this property to <br /> perform the work for which application is made,and 1 comply with the State Contractors Law 1 8.27 RCW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> ') PERMIT# <br /> — PW 0s3 <br /> Authorized Agent Signature Date (Revised 9/231201 6) <br />