10200 19TH AVE SE 2021-12-23 - Laserfiche WebLink

az IBLIC WORKS PERMIT APPLICATION 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 I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:10200 19th Ave SE, Everett, WA 98208 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: �y DRAINAGE MITIGATION QUESTIONS: ❑FENCE IN ROW ,�/{ FT IN HEIGHT STORMWATER DISCHARGES TO: ❑DRIVEWAY APRON/CURB CUT ..,2 FT WIDE ❑Combined Sewer ❑✓ ASPHALT/CONCRETE PAVING 5110 t r s q q) le SF (Separated Storm Sewer ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY pi LF 0 Direct Discharge to Snohomish River or Puget Sound El RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑CLEARING/GRADING/FILL/EXCAVATE 0 CY El MR2 Only I -MR1-5 El MR1-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: V SF ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: /o, ri q(11' SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced:Replace existing SF lU rty0 ADA SITE UPGRADES CONTACT INFORMATION OWNER/APPLICANT NAME: RENE ATKINSON- MG2 OWNER/APP. MAILING ADDRESS: STREET 1101 SECOND AVE., SUITE 100 CITY SEATTLE STATE WA zip 98101D OWNER/APP.PHONE:(206) 962-6578 OWNER I APP.EMAIL:rene.atkinSon@mg2.com 'Required for Work in Public Right-of-Way CONTRACTOR NAME: TBD lac LA- NI0-rI IG`l kJ t4r43 50,ticrith CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑✓ OWNER I APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer,Etc.) CONTACT� NAME: CONTACT PHONE: 2,04 c(p 2, 4518/ 6g11 (Y�Ng ArvINsesi/eust-lik.PfAsom CONTACT EMAIL: rev.eett 4rsone, t{,42,. COM m a• rsoA 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 F" "41 " authorized in writing from the Building Official before being authorized under any circumstance.lam the owner,or 1 am authorized by the owner of this property to perform the work for which application i ade,and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. �}, City of Everett Official Use Only "� 7/14/21 PERMIT# PW r V l ter/Authorized Agent Signature Date (Revised 1/72019) — l,