710 84TH ST SE 2021-12-23 - Laserfiche WebLink

• PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 4rETT (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION. PROJECT ADDRESS: —2 (6 — ? tr t h ST. S I (/ I a (,,,A SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX DADU ❑MULTI-FAMILY OCOMMERCIAL DINDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) IF APPLICABLE: 0 FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# DESCRIPTION OF SITE WORK I RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: TiSi DRIVEWAY APRON/CURB CUT r�S '•>(°\•() FT WIDE 0 Combined Sewer ❑ASPHALT/CONCRETE PAVING SF 0 Separated Storm Sewer ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ Direct Discharge to Snohomish River or Puget Sound ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑CLEARING/GRADING/FILL/EXCAVATE CY El MR2 Only ❑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: l) OcC) SF R d- lZ C;c� Civ:i, wcy • CONTACT INFORMATION . . OWNER/APPLICANT NAME: p u 1„u Tc p OWNER/APP. MAILING ADDRESS: STREET �r�' -) (v -?kf I' J•`)- Si; CITY (i(/Yd't Lf STATE 1,A / J zip OWNER/APP.PHONE: OWNER!APP.EMAIL: "Required for Work in Public Right-of-Way II,, U'0� _\ C J 2 - \ 32 CONTRACTOR NAME: j CJC Uk"`Wk.[i CONTRACTOR ADDRESS: STREET ( 1_0 3 1 —l( fr" A z er" . .e VVV‘ A,P..)4 (,yy 4-1- CITY i -STATE �jt/f -- ZIP CONTRACTOR PHONE: 3 6.0 g�C/— If 7 7 ) CONTRACTOR EM IL: \ ' vtJEDC( i-sLJ-V -`L . C CIA CONTRACTOR LICENSE#(REQUIRED): 1 td NIcioft(► �Q EVERETT BUSINESS LICENSE#(REQUIRED): 5/,�3 1 PRIMARY CONTACT: 0 OWNER /APPLICANT FCONTRACTOR ❑OTHER`(Rrchitect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 3(G/ 2—)- 6-7 7 Jae_ �(;—� C CONTACT EMAIL: I,rt...(ck„,y,) (/z k) 4,-i-t , 1 _ccN— ACKNOWLEDGEMENT.I have reviewed t is 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 Buildin. 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 applic- .n is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only / f- PERMIT /f �� c, Pw \�O — 0S3 Own: / �o • •ge Si•••ture Date (Revised 1/72019)