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IIF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) <br />IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT # <br />UTILITY COMPANY'S NAME & JOB M JOB # <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 q_�5,5 SF <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF <br />❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT <br />❑ CLEARING / GRADING / FILL / EXCAVATE <br />❑ CUT/BORE IN PAVEMENT (PARALLEL) <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) <br />❑ POLE WORK / AERIAL / OVERLASH <br />DESCRIPTION (AS NEEDE <br />FT TOTAL HEIGHT <br />CY <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: M5 <br />❑ MR2 Only ❑ MR1-5 ❑ MR1-9 <br />LF QUANTITY OF PROPOSED HARD SURFACES: p <br />LF Proposed Roof Area: DD � SF <br />LF Proposed Hardscape: q T-55 S SF <br />Total New+Replaced:- i,3,63'5 SF <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. I am the owner, or I am authorized by the owner of this property to <br />perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />'1 PERMIT # <br />c� c� (�'( PWv�> 1 -� <br />Owner/Authorized Agent Sibvbture Date (Revised 1172019) <br />