3114 WAVE DR 2022-03-23 - Laserfiche WebLink

El P03LIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 3 114 w k) l� �� V LT- 0 l � Z� 7 SITE WORK FOR PROJECT TYPE: ❑✓ SFR-DETACHED ❑TOWNHOUSE []DUPLEX ❑ADU ❑MULTI -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 # 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 SF ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT 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: STORMWA TER 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: SIS SF Total New + Replaced: 3 7� SF P CONTACT INFORMATION OWNER I APPLICANT NAME: �d OWNER / APP. MAILING ADDRESS: STREET 3 I t- L' V t� i L CITY STATE tiC/{1 ZIP Ij L L� OWNER I APP. PHONE: Zb L -4 OWNER I APP. EMAIL: (tf LL-'q S� I -j ,r- M N y-e ([). `Required for Work in Public Right -of -Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: INOWNER / APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 26L- Z?ice Y CONTACTEMAIL:tvL at(41 ACKNOWLEDGEMENT: I have r�viewed this application and confirm the information contained herein is true and co rect. 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 dovktions 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 # � 67 P30 PW Z v tv C),03 Owner/Authorized Agent Signature D e (Revised f/72019)