215 DORN AVE 2022-01-24 - Laserfiche WebLink

PLIC WORKS PERMIT ,iI 'LICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 4 FAX 425-257-8857 I(E)everetteps@everettwa.gov I https://everettwa,gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2 15 O O Y n R\Le. E-V E'Y e+ / (,1/4)Pt. ct 8 2,0 8 SITE WORK FOR PROJECT TYPE: OSFR-DETACHED OTOWNHOUSE liSIDUPLEX DADU I:MULTI-FAMILY ❑COMMERCIAL D1NDUSTRIAI- 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 I RIGHT.OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: 0 FENCE IN ROW FT IN HEIGHT STORMWATiR DISCHARGES TO: ❑DRIVEWAY APRON f CURB CUT FT WIDE 0 Combined Sewer ASPHALT I CONCRETE PAVING SF 0 Separated Storm Sewer ❑RETAINING WALL!ROCKERY IN RIGHT-OF-WAY LF 0 Direct Discharge to Snohomish River orPuuet Sound RETAINING WALL!ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑CLEARING/GRADING/FILL/EXCAVATE CY ❑MR2 Only ®MR1-5 0 MR1-9m ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: 0 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF 0 POLE WORK I AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: _.. SF N e itA3 ti W 4e ( Pe,Y s e-1 rn;-E-- P Val ISO_3 0 t CONTACT NFOR TIQN OWNER/APPLICANT NAME: U\ S G►5 S re.g Y CA \I e.ck OWNER/APP. MAILING ADDRESS: STREET !1 12 Lj 5 8+ Ave.. S L CITY 11 d lirkG T.54\ STATE w Zip 1 132 l OWNER!APP.PHONE;0-53) 8 3— ¶"81 OWNER/APP.EMAIL:Si e'C TYCASYN I�nai 1 -CO(Y\ 'Required for Work in Public Right-of-'Way` CONTRACTOR NAME: V t c s e.5 S T v e& CONTRACTOR ADDRESS: STREET j I -2-LI -t-kA I1 J e- S city 5-kel o t''t d rY+ ► STATE U)h aIP182. CONTRACTOR PHONE;(25,3)eci3— g 18 CONTRACTOR EMAIL: 5 i Yres,b .cAry in Lta,)171c4.; 1- Co ri CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENS #(REQUIRED): PRIMARY CONTACT "�1 OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect,Engineer,Etc.) CONTACT NAME: CONTACT PHONE: U `rSe_S S re ATCl CONTACT EMAIL: •5Le �yafnc,n �� >�ct,'�.Cor» ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Kirk done rsuent 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 8uitding 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 295.200A WAC. City of Everett Official Use Only e 'PERMIT