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PI@LIC WORKS PERMIT AWLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https://everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS:2325 75th ST <br />SITE WORK FOR PROJECT TYPE: OSFR-DETACHED ❑TOWNHOUSE [-]DUPLEX ❑ADU ❑MULTI -FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br />IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) <br />IF LCABLE: ElFRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT # <br />UTILITY COMPANY'S NAME & JOB #: JOB # <br />DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK <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 SF <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF <br />❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br />0 CLEARING / GRADING / FILL / EXCAVATE 260 CY <br />❑ CUT/BORE IN PAVEMENT (PARALLEL) LF <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF <br />❑ POLE WORK / AERIAL / OVERLASH LF <br />ADDITIONAL DESCRIPTION (AS NEEDED): <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWA TER DISCHARGES TO: <br />❑ Combined Sewer <br />❑ Separated Storm Sewer <br />❑ Direct Discharge to Snohomish River or Puget Sound <br />TRIGGERED REQUIREMENTS: <br />❑ MR2 Only ❑ MR1-5 ❑ MR1-9 <br />QUANTITY OF PROPOSED HARD SURFACES: <br />Proposed Roof Area:2102 SF <br />Proposed Hardscape: 1211 SF <br />Total New + Replaced:3313 SF <br />New SFR infilltration proposed <br />CONTACT INFORMATION <br />OWNER I APPLICANT NAME: Haack Brothers Homes <br />OWNER / APP. MAILING ADDRESS: ITREET3922 87th AVE NE <br />CITY Marysville STATE WA Zip 98270 <br />OWNER / APP. PHONE:425-290-2429 <br />OWNER / APP. EMAIL:joel@haaCkbrothers.COnl <br />'Required for Work in Public Right -of -Way <br />CONTRACTOR NAME: Haack Brothers Homes <br />CONTRACTOR ADDRESS: IT11IT3922 87th AVE NE <br />,,,,, Marysville STATE WA ZIP 98270 <br />CONTRACTOR PHONE:425-290-2429 <br />1CONTRACTOR EMAIL:joel@haaCkbrothers.COn1 <br />CONTRACTOR LICENSE #(REQUIRED): <br />EVERETT BUSINESS LICENSE #(REQUIRED): 053967 <br />PRIMARY CONTACT: ❑ OWNER / APPLICANT ❑✓ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: <br />Joel Haack <br />CONTACT PHONE:425-29*0-2429 <br />CONTACTEMAIL:joel#haackbrothers.com <br />ACKNOWLEDGEMENT. I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must <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 1 am authorized by the owner of this property to <br />perform the work for which application is maide, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Agent Signature <br />Date <br />City of Everett Official Use Only <br />PERMIT # <br />PW '�_d l U 09 <br />(Revised 1172019) <br />'1Z <br />