2431 CLEVELAND AVE 2021-05-04 - Laserfiche WebLink

P3LIC WORKS PERMIT bPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I https://everettwa.gov/permits ' ''/' PROJECT SITE'INFORMATION PROJECT ADDRESS: L VI 3 I C I Fed C> In(0 ot v e r v61-' 14-/ 14I/4-- SZA SITE WORK FOR PROJECT TYPE: ILISFR-DETACHED ❑TOWNHOUSE DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) DESCRIPTION Of SITE WORK`/ RIGHT:OF.- WAY.WORK . FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: FENCE IN ROW 1. ? - 72 I`r\ A1cs FT IN HEIGHT STORM WA TER DISCHARGES TO: ❑ DRIVEWAY APRON/CURB CUT FT WIDE 0 Combined Sewer ❑ASPHALT/CONCRETE PAVING SF ElSeparated Storm Sewer .¢Y RETAINING WALL/ROCKERY IN RIGHT-OF-WAY '0 LF 0 Direct Discharge to Snohomish River or Puget Sound ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: 1 CLEARING/GRADING/FILL/EXCAVATE L( CY 0 MR2 Only ❑ MR1-5 ❑ MR1-9 ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OFPROPOSED HARD SURFACES: ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposep Roof Area: SF''.. ❑ POLE WORK/AERIAL/OVERLASH LF PropoedNardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+'Replaced: ' ;TSV IP r►m c1 Dc-scrti rI- A # = �- CONTACT'IN F O RNMAT I oN. . OWNER/APPLICANT NAME: 4QGb/Y) .I OWNER/APP. MAILING ADDRESS: STREET (�14 S I \J (j evrf LGtN�. c,i U /1 G CITY IN v( STATE wA- ZIP 4�4 1 OWNER/APP. PHONE: Z& - 9'3 1 -'7`vACYctGT OWNER/APP.EMAIL: *Required for Work in Public Right-of-Way CONTRACTOR NAME: LI b('r11-l Fen C.e CONTRACTOR ADDRESS: STREET 7 0( 2C t o 3 rd p ( N P CITY p otr (5 ,i) •`d STATE WA. ZIP CONTRACTOR PHONE: L` 2.5 v Z(`- 74 7 6Z CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED) L T 6 F L I #(R D) I11 gz(� Q D� EVERETT BUSINESS LICENSE EQUIRE .. ,.,.a� _.,..,� .�.., � Q...a.. �1 .-�..�.IL .�.a ,.,. ,„ va. .. .= R�.�..o�., _ . .. _.. PRIMARY CONTACT: OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: / CONTACT PHONE: 20 6j ot 3 ( - Z.df q 9 /T M C� CONTACT EMAIL: G(,C6/ ) , J,4ulo • Scli. (.,1ma,( , con') ACKNOWLEDGEMENT-I have reviewed this application and confirm the information contained herein is true and correct.TNork done pursuando 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# 03 f 1& 7z0 Pwz003--o Z' Owner/Authorized n re Date (Revised 4/15/2019) (10---