4308 GRAND AVE 2022-02-14 - Laserfiche WebLink

fLIC 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: L1 ( 6y J fi/It_ SITE WORK FOR PROJECT TYPE: $SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU 0 MULTI-FAMILY ['COMMERCIAL ['INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) • DESCRIP.,TION:QF.. ITE.WOR C hR1CH `QF;WAIF:'.1N R . FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑ FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: ❑ DRIVEWAY APRON/CURB CUT FT WIDE .,Combined Sewer ASPHALT/CONCRETE PAVING 425-0 SF ❑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 1.3,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: 9( SF ❑ POLE WORK!AERIAL/OVERLASH LF Proposed Hardscape: , n fD O SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: 1 , O C,n SF CONTACT INFQR IATION OWNER/APPLICANT NAME: `nl l>� U c5'i ii I OWNER/APP. MAILING ADDRESS: STREET Lt 3 C t G,„f krt.- !r CITY ivtGYvLter STATE r ZIP 4 p 7-03 OWNER/APP. PHONE & 5.-7Q,,I 6>.(5 �. ,, OWNER/APP >EMAIL ..., .. .,q.0. .... ..... . ...." .., ....., k._ . *Required for Work in Public Right-of-Way CONTRACTOR NAME: ,_1),3,11Q( Civ-r(ne,,, CONTRACTOR ADDRESS: I V d STREET D�(m (te y. CITY ;y STATE iiti4- ZIP 9mf( CONTRACTOR PHONE: 112S- ,3s-0-6-Z42 CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED) (p(f 3 j� ( �-( EVERETT BUSINESS LICENSE#(REQUIRED) kGf,KFRL`,(.Lc/v\ PRIMARY CONTACT: OWNER /APPLICANT 0 CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: ((� CONTACT PHONE: E(g_ '�( - /I55 /Vli,\ ti 11Mt N. CONTACT EMAIL: ()Ail yti G{✓a he,w.@ A.01-vvv4 csev\ 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 work 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# �.� r�-2'1 2czo PW 2O02- O3fc Owner/A rized Agent Signature Date (Revised 4/15/2019)