5625 EVERGREEN WAY 2021-05-04 - Laserfiche WebLink

PISLIC WORKS PERMIT A•LICATION 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: . -c E 'ireii.ri i ►9 , SITE WORK FOR PROJECT TYPE: 77 SFR-DETACHED L)TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ,, COMMERCIAL 'nINDUSTRIAL IF APPLICABLE: LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: FRANCHISE/UTILITY COMPANY.ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# DESCRIPTION OF SITE WORK / 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 W FT WIDE LI Combined Sewer ❑ASPHALT/CONCRETE PAVING SF n Separated Storm Sewer ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ 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 Li MR2 Only 71 MR1-5 n MR1-9 Li CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: Li 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 victit> ,��a �L�Ir � � fi 41 La)(1- 1 i A Jr (mo t q . ›fect f iror tb_ nad .11A eth ca) ((i a II Mix) .-1-L2. /'64-1;k9 c H r - 04.); '�r CONTACT INFORMATION OWNER/APPLICANT NAME: ZI11 en II(A cc 1 OWNER/APP. MAILING ADDRESS: STREET C , z.velJIln .}°��- \ A f� y CITY z-v t1 STATE S/ - ZIP r 1' OWNER/APP. PHONE: 2 i- - �i\ ( - 6 /6 !OWNER I APP. EMAIL: 2 C/t it(Ark I I vI 6 (C)7t,t. g Al I 1 f!! *Required for Work in Public Right-of-Way t CONTRACTOR NAME: to Scale Lan CONTRACTOR ADDRESS: STREET 1)I C )Ii1:I ( \1 th ST --ft CI CHY 1,1i r �.i1 STATE ZIP q l I O t CONTRACTOR PHONE: f-N;.V 1 — 1 'CONTRACTOR EMAIL: t V) (C(/1 G / WO' CONTRACTOR LICENSE#(REQUIRED): 1y or� EVERETT BUSINE S LICE ISE tf(REOUI ED): PRIMARY CONTACT: I OWNER /APPLICANT (°CONTRACTOR I]OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: i t - ckt cete LciAtj CONTACT EMAIL: 0/��4I. fikAi! • LV n'I ACKNOWLEDGEMENT:I have reviewed thig application and confirm the information contained herein is true an I 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 1 PERMIT# PWZO1 - Orb Owner/Authorized Agent i ature Date (Revised 1/72019)