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s <br />/ 0 • <br />PUBLIC WORKS PERMIT APPLICATION' <br />CITY OF EVERETT PERMIT :SERVICES <br />V E R E T T 3200 CEDAR STREET _EVERETT, WA;98201, <br />WAOMINOTON (P) 425-257.8810 1 FAX 428-2-57-8857 l(E)evereltsP 8@8verettwa.govi hltps:/teverettwa.gov/pert7Oits= <br />�fli?!RO.II4�GT�;�i'"":IN18#thll,igiTtOiei U77 <br />PROJECT ADDRESS; 1 yJ <br />SITE WORK FOR PROJECT TYPE: [38FR DETACHED' ( ITOWNHOUSE;QDUPLEX ❑AW. ❑MULTI -FAMILY 066MMERCIAL ❑INDUS*At <br />IF APPLtGABLE: Ul LAND USE PROJECTt#;(SEPA,:PRE-APP SS, ETC)go9,w 50AZOV44-gre <br />W APPLICA'BLE. 0 FRANCHHISEIUTILITY COMPANY, ANNUAL BLANKET PERMIT # <br />UTILITY COMPANY'S. NAME & JOB, 0., JOB# <br />OkW 1 t3 T.� lip fi4 A tN�IYti <br />FILL IN AEC gtlANTt fiEs OF WCRfI;BELOINF AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS. <br />FENCE 1�W FT IN HEIGHT STOF7MWATER DISCHARGES TO; <br />d DRIVEWAY APRON I CURB CUT FT WIDE 0 Combined"Sewer <br />IA ASPHALT I CON"CRETE PAVING I rod SF 91 Separated Storm Sewer <br />RETAINING WALL # 90,0 0kY INRIGHT-OF-WAY LF ❑ D eat Dlschsr s t9 Srxattamtsb RN.er of PugetSound <br />CI RETAINING WALL I ROCKERY OVER dFT Its HEIGHT FT TOTAL, HEIGHT TRIGGERED REQUIRgMENTS' <br />0 CLEARING 1 GRADING / FILL I EXCAVATE l 4J Cl' CI MR2 only j j"MEt18 E] MR14 <br />CUT/80RE'IN PAVEMENT (PARALLEL). LF QUANT"OF'PROPOSED HARDSURFACES. <br />CUT/$ORE~ IN PAVEMENT(NON-PARALLEL) V Proposed Roof Area: i SF <br />El POLE WORK I AERIAL I°OVERLASf LF Proposed F{atdscape 14W. <br />'# 1— s>r <br />ADDITIONAL DESCRIPTION(AS NEEDEDT Total Now #Re laced; IltiI SF <br />T t i3tmt litjlTH WAVWAL-si 1. '4-w 7- n tz <br />F, j""p- sy P44— I"� f Wit= TO I <br />E <br />OWNER /APPIUCANT.NAME: t)k p ,JLL BLAALCHAOLO <br />OWNER IAPP. MAILING ACORESS: sTRaET Its e S+ Stj <br />STATE. ZIP <br />OWNER I APP. PLONE: . ` c OWNER I APO. EMAIL: (J4"W"ck'4f 5 }^e} '" , <br />'Required for Work 16 Publto RlgKofMay <br />CONTRACTOR NAME: U Wl- AJ - t i t-t F Vr AT e `I0 - -c s <br />CONTRACTOR ADDRESS pmeat <br />CITY STATE ZIP; <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #i(REQUIREO)-. EVERETT BUS <br />1NE8J LICEN8E ri(Rlr tUlFtEt)}: <br />PRIMARY CONTACT: ❑ C)WNER /APPLICiANT El CONTRACTOR CI OTHER (Ardhllect, Engineers Etc.) <br />CONTACT`NAME. CONTACT PHONE <br />CONTACT EMAIL: <br />true and correct. Work done pursuant to this permit must <br />final no dWSffons therefrom, D&WaIlans must first Be <br />Wer,"or! ant aufliortzed r y the owner. of tlsls property to I <br />Arid 290:200A WAG. <br />Cl(WE'veret(O7flctst Use Only � <br />PERMIT <br />PIf <br />(RBWsed 1/72019) <br />