4841 GLENWOOD AVE 2021-06-09 - Laserfiche WebLink

P.LIC WORKS PERMIT APLICATION ra CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 https://everettwa.gov/permits PROJECT SITE INFORMATION f , PROJECT ADDRESS: "1 L\\ &1-e1'l�C)06 C\--(-€ ENR% ( Oj -� ?t O SITE WORK FOR PROJECT TYPE: SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX DADU ❑MULTI-FAMILY OCOMMERCIAL DINDUSTRIAL IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) DESCRIPTION OF SITE.VWORIC I.RIGHT-OF-WAY;WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑ FENCE IN i?OW FT IN HEIGHT STORMWATER DISCHARGES TO: ❑ DRIVEWAY APRON/CURB CUT FT WIDE 0 Combined Sewer ❑ASPHALT/CONCRETE PAVING SF ❑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 0 MR2 Only ❑ MR1-5 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 CONTACT:INFQRiIATION e - OWNER/APPLICANT NAME: r_.. (lam \Th( (Y'A'(Y1 — )610(..k.3,01..- �gC� i t� `'` ?L . OWNER/APP. MAILING ADDRESS: STREET t f . 1 � � j /v7��Y(� CITY, QO( l STATE A(' ZIP #VS- 't' OWNER/APP. PHONE: w .Sit -Ut 13\ OWNER/APP. EMAIL:„ S�'lCt Q•Y1'(Yll(, . jUL�� CLC *Required for Work in Public Right-of-Way 0,5L c.-C a.,i,„,f/r7W 15„.ee. &a ree,ry►,, ;etv ' (.°a, d CONTRACTOR NAME: t C tt Z C\ G U &tC�' CONTRACTOR ADDRESS: 1,Ai49 STREET . \ CITY C.ULYZv='tT STATE ''t^iA— ZIP 971.15 CONTRACTOR PHONE: 42 5 .2 )S - "2'2 2 Se CONTRACTOR EMAIL: C- -2-a0 t 'fl 0 L�4 L= ,C iL/A CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑ OWNER /APPLICANTR ,(LE-'y -€,€ �. •,-N �- . .4 CONTRACTOR -OTHER(Architect, Engineer, Etc.)(2 2 -' ' \ CONTACT NAME: CONTACT PHONE: 'I.CZS_ Z((6 , 2 ZZ99' •4-4-11 1 �-c`4- ' i�_ CONTACT EMAIL: C-. ..¢(j:..CtiL 2�� L., �,t (.0,4t �V�V�30aIi')L4\c^ ` ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must `-J ' 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. Cit of Everett Official Use Only / ' PERMIT# (-- 30 (i_oi 9 PWuS \ ,0°\ -06 2, Oivirier/Authorized Agent Signature Date (Revised 4/15/2 9) J