1512 81ST PL SE 2021-09-01 - Laserfiche WebLink

11103LIC WORKS PERMIT IPPLICATION 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: S 1Z I �`. f `" tt `,,_)A SITE WORK FOR PROJECT TYPE:. .JSFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) " DESCRIPTION OF:SITE 1NORK 1.RIGHT OF-NAY woRIC. • 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 ❑Combined Sewer %ASPHALT/CONCRETE PAVING 5 d 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 ❑ 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: SF ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: SF AlEV.1 !D f V4IPC K 66/Lo,•t6 PfivCD VR-+vrwA-' - Sv¢_FAC-E Cac(STr ie "DR1�/ CONTACT INFORMATION., . OWNER/APPLICANT NAME: ( /- 7, 7r,y , -/r zy-ice OWNER/APP. MAILING ADDRESS: STREET /c/Z ,f/ S" A Xc CITY C- 'f / 1 4 STATE (Cr/9 ZIP / L O OWNER/APP. PHONE: (1-7' 2 G/7/ 3 2YZ___ OWNER/APP.EMAIL vCS Jc - c l7 it *Required for Work in Public Right-of-Way V (U/ CONTRACTOR NAME: 0 LJ ( CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: SA-I.IZ CONTACT EMAIL: ACKNOWLEDGEMENT.'1 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 PERMIT# /77/ 170 /47i:( M). pw z_oaz - 6 /16 Owner/Auth !zed Agent Signatur Date (Revised 4/15/2019)