2332 BROADWAY 2022-01-24 - Laserfiche WebLink

' PU LIC WORKS PERMIT AP LICATION CITY OF EVERETT PERMIT SER S EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2332 Broadway Ave SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY ❑✓ COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) EPLICABLE: ❑ FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME & JOB #: JOB # DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON / CURB CUT FT WIDE ❑✓ ASPHALT / CONCRETE PAVING 3 SF ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT 1 CLEARING / GRADING / FILL / EXCAVATE CY ❑ CUT/BORE IN PAVEMENT (PARALLEL) LF ❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF ❑ POLE WORK / AERIAL / OVERLASH LF ADDITIONAL DESCRIPTION (AS NEEDED): DRAINAGE MITIGATION QUESTIONS: STORMWATER DISCHARGES TO: ❑ Combined Sewer ❑ Separated Storm Sewer ❑ Direct Discharge to Snohomish River or Puget Sound TRIGGERED REQUIREMENTS: ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 QUANTITY OF PROPOSED HARD SURFACES: Proposed Roof Area: SF Proposed Hardscape: SF ITotal New + Replaced: SF The propertv owner is seekinq to conduct three (3) soil sampling/testinq borings on a suspected contaminated soil area within the public riqht-of-wav adiacent to the oroiect site in order to identifv the extent of contamination and costs necessary to remove contaminated soil. CONTACT INFORMATION OWNER / APPLICANT NAME: HNM LLC OWNER / APP. MAILING ADDRESS: STREET 719 Grand Ave CITY Everett STATE WA ZIP 98201 OWNER / APP. PHONE: �7 ' ��B { Z LL OWNER / APP. EMAIL: l� e1" U OT'W1U l GD 'Required for Work in Public Right -of -Way CONTRACTOR NAME: Cascade Drilling CONTRACTOR ADDRESS: STREET 19404 wood inville-Snohomish Road CI1Y Woodinville STATE W, Q ` ZIP 98072 CONTRACTOR PHONE: 425-322-0289 CONTRACTOR EMAIL: kgoble@cascade-env.com CONTRACTOR LICENSE #(REQUIRED): CASCADL91508 EVERETT BUSINESS LICENSE #(REQUIRED): 47589 PRIMARY CONTACT: ✓❑ OWNER / APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) CONTACT NAME: Maddy Metzger CONTACT PHONE: 12-ry ` 4 `S -7 �C Z CONTACT EMAIL:metzgerutt@hotmail.com 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. 1 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 # PW l & Z- AD (Revised 1172019)