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PIOLIC WORKS PERMIT iPLICATION 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 J https://everettwa.gov/permits '"'r�R'+�.` �-.,,.yap, - � e�m�� 'h � 't� S. � . q ,�.. tra CST SIT 1 R` R ION t "��1414, PROJECT ADDRESS: 67 Q (.p ►✓LO C2-6Ala 12-1 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ['TOWNHOUSE ❑DUPLEX ❑ADU EMULTI-FAMILY ['COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# SCR MO O 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 LI Combined Sewer ❑ASPHALT/CONCRETE PAVING SF Separated Storm Sewer ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ Direct Discharge to Snohomish River or Puget Sound El RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: 154 CLEARING/GRADING/FILL/EXCAVATE 4 CY MR2 Only El 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 OWNER/APPLICANT NAME: _® OWNER/APP. MAILING ADDRESS: STREET 1D0(0 cva-C�rR,...1 o. /�PC CITY 'EV z'��,j�C STATE \L,1 ZIP 9�.7 Q 243 OWNER/APP.PHONE: OWNER/APP.EMAIL: *Required for Work in Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET {JLJLO t `2 C� .Q.11-1' • --o CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): ._ PRIMARY CONTACT: ❑ OWNER /APPLICANT CI CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) ....... .. CONTACT NAME: CONTACT PHONE:(c .2 8- 6 9 I S - o t 4 �p �£. CONTACT EMAIL: \ 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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made,and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# °�� 7Jla(�� PW 2.t0 7- 03-7 Owner/Authori Agent Signature Date (Revised 1/72019)