12011 19TH AVE SE PARKING LOT 2021-12-23

PI.oLIC WORKS PERMIT A'LICATION 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:12011 19th Avenue SE SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU EMULTI-FAMILY ❑✓COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.)Landscape Modification 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: DRAINAGE MITIGATION QUESTIONS: ❑FENCE IN ROW 0 FT IN HEIGHT STORMWATER DISCHARGES TO: ❑DRIVEWAY APRON/CURB CUT 31' incl. side ramps FT WIDE ❑Combined Sewer ❑ASPHALT/CONCRETE PAVING 13,715 SF 0 Separated Storm Sewer ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY 270 LF ❑ Direct Discharge to Snohomish River or Puget Sound ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT 5 FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑CLEARING/GRADING/FILL/EXCAVATE 765 CY ❑ MR2 Only ❑ MR1-5 © MR1-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) 0 LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) 0 LF Proposed Roof Area:0 _SF ❑POLE WORK/AERIAL/OVERLASH 0 LF Proposed Hardscape:4400 _SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced:206/50 _SF j-_ c7-I.3hl c J F iv F-,,i /�. .,n'-7 P i- , -,rw G- I t=�✓L- 7/ C-?R-�(^ (-re "I At.&—T 124II-1�r� (' �✓1- EM�,(L7 J P-4:4 y�vix-✓�►.tr A'-I'dnff ( 571)) 4-Vie- Aw, St—IL�6- T FJU Y- N El") L O A,�AA �- (Lc.l L. L 8 G, L ni .(' �,'W h I J tld"c c ,q-l?-9 J�3 I2 0�,w':j—L-1-h. An �� CONTACT INFORMATION Ll 1-p ti .4N0 OWNER/APPLICANT NAME:Emory's Lakehouse, LLC (lk P 1t-Q vf- - -IOd Tr, OWNER I APP. MAILING ADDRESS: STREET 11830 19th Avenue SE CITY Everett STATE WA ZIP 98204 OWNER/APP.PHONE:(425)232-8809 OWNER I APP.EMAIL:emory.cole@gmail.com *Required for Work in Public Right-of-Way CONTRACTOR NAME: TBD CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER /APPLICANT ❑CONTRACTOR ©OTHER(Architect, Engineer, Etc.) Architect CONTACT NAME: CONTACT PHONE:(425)348-3975 Fred Baxter, A.I .A. CONTACT EMAIL:fred@baxterarchitects.com 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. I am the owner,or I am authorized by the owner of this property to perform the wDrk 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# " ' i z -� PW IRO( -n 62 0 ' ^.uthoriV it nt Signature Date (Revised 1/72019)