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F43'LIC NWORKS REPNOT AM PLICATION <br />"a'`»t CITY OF EVERETT PERMIT SERVICES <br />EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https://everettwa.gov/permits <br />PROJECT ADDRESS: 10 10 56 L-_V Mb12tL- s217E I Ll <br />SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU []MULTI -FAMILY ®COMMERCIAL ❑INDUSTRIAL <br />IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) <br />DESCRIPTION OF S E WaRiK Rigw00*k .WbRit <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />❑ FENCE IN ROW FT IN HEIGHT <br />❑ DRIVEWAY APRON / CURB CUT FT WIDE <br />❑ ASPHALT / CONCRETE PAVING SF <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF <br />❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br />❑ CLEARING / GRADING / FILL / EXCAVATE CY <br />❑ CUT/BORE IN PAVEMENT (PARALLEL) LF <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF <br />❑ POLE WORK / AERIAL / OVERLASH LF <br />ADDITIONAL DESCRIPTION (AS NEEDED): <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />® Combined Sewer <br />® Separated Storm Sewer <br />® Direct Discharge to Snohomish River or Puget Sound <br />TRIGGERED REQUIREMENTS: <br />❑ MR2 Only ❑ MRI-5 13MR1-9 <br />QUANTITY OF PROPOSED HARD SURFACES: <br />Proposed Roof Area: SF <br />Proposed Hardscape: SF <br />Total New+ Replaced: SF <br />F6 c ,ice 4N' E n, <br />oe -o <br />OWNER I APPLICANT NAME: i5v6kCIT MALL QEE10E BViLD(ti I-L-C <br />OWNER / APP. MAILING ADDRESS: STREET l g2cf Ave J SZ I <br />CITY (7 i fri ISi� STATE ZIP cjgZqjp <br />'�1%{} <br />OWNER/ APP. PHONE: OWNER / APP. EMAIL: r K <br />'Required for Work in Public Right -of -Way <br />CONTRACTOR NAME: PL-2 Z t Cf( SY}C <br />_rH T 8 <br />CONTRACTOR ADDRESS: STREET 210 <br />Q ��Z <br />CITY CJ -y O H6 L L STATE ZIP q 0Z <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: S Wf1RNl� LDt2 CN- SS Gt�M <br />CONTRACTOR LICENSE #(REQUIRED): CC, AMIA4 21Z <br />EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER /APPLICANT ❑ CONTRACTOR 53"OTHER (Architect, Engineer, Etc.) AVV_C.i41`fEC_i <br />CONTACT NAME: <br />CONTACT PHONE: 2_0 b • % (' 6 , 0 <br />CONTACT EMAIL: I SaELL. .4n 4 L C e <br />ACKNOWLEDGEMENT: 1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must <br />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 <br />authorized in writing from the Building Official before being authorized under any circumstance. 1 am the owner, or I am authorized by the owner of this property to <br />perform the work for whi lication is made, and 1 co ply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />-01V PW Vs- <br />Owner/Authorized Agent Signature Date (Revised 411512019) <br />iz <br />