2410 GRAND AVE 2021-06-09 - Laserfiche WebLink

Nom P3LIC WORKS PERMIT PLICATION ix CITY OF EVERETT PERMIT SE-r CES 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 ., I PROJECT ADDRESS: C.`I /Q 6ca1 ../ /j VGA E.ve:-e r"t �{%A ' Z 0b SITE WORK FOR PROJECT TYPE: IgSFR-DETACHED ❑TOWNHOUSE ❑DUPL'EX DADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: CI LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) ,i. 4 DESCRIPTION,OF SITE WORK,[RIGHT-OF-WAYWORK 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 FT WIDE ri,Combined Sewer ❑ASPHALT/CONCRETE PAVING SF ❑ 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 66:‘ CY ,MR2 Only ❑ MR1-5 ❑ MR1-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: c97.) SF ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: � SF t l e -1,ci Vl (5 1 I'°L 4/GL 1 i t ee y I/-.7i J / f 7 2- - I 1", a 1 I e( - .. °, CONTACT:INFOR: ATION . OWNER/APPLICANT NAME: )eA fri-e c 12 i`e, C(' `r I`h I OWNER/APP. MAILING ADDRESS: STREET (I 1 U L I i I I,- `L/ 6- /CITY 4 p C' 1l''fie STATE kJ-A ZIP ct v /y OWNER/APP. PHONE: Z 0 ( 2 Z 7 Li<<7 fi OWNER/APP. EMAIL: e+r'e i e/� ) 44e.c h 7-rn ct; 1 C d"ti *Required for Work in Public Right-of-Way CONTRACTOR NAME: T(7 '/ CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: C.ROWNER /APPLICANT ❑ CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: (� CONTACT PHONE: 2 O - Z 2 7 Lj / 46 To-me? Pr fef^ CONTACT EMAIL: c1reIe/ -.)ame, r7 11e 'i , Je d'"1. 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.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 e--)471 PERMIT# Own authorized Agent Signature Date (Revised 4/15/2019)