10923 PAINE FIELD WAY 2022-03-07

IeBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 47IETT (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION, PROJECT ADDRESS: tee(/ Z 3 I'��, t vt� f. 'i? w J-y' 1 /t f'T/ C A-- qi i 611 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: DRAINAGE MITIGATION QUESTIONS: ❑FENCE IN ROW 3 ' S FT IN HEIGHT STORMWATER DISCHARGES TO: ❑DRIVEWAY APRON/CURB CUT r^ FT WIDE ❑Combined Sewer ❑ASPHALT/CONCRETE PAVING S.00 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 ❑MR2 Only ❑MR1-5 0 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: SF CONTACT INFORMATION................' . OWNER/APPLICANT NAME: E;4,7O 1 Lit OWNER/APP. MAILING ADDRESS: STREET j Fi Cf Z &.. t t"•- e Ly CITY r or Tr STATE L r ZIP 1 1-'y OWNER/APP.PHONE: 2 6j - 3 - 1" Ski OWNER/APP. EMAIL: L'_ex/L'�h�/r��C'=� } 6"y2zc..I:(.v --7 *Required for Work in Public Right-of-Way CONTRACTOR NAME: 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.) CONTACT NAME: CONTACT PHONE: 6 5 (�. q ' 0 J < Y�Z Cam(•'��1 I L � h(: j CONTACT EMAIL: e�✓(Li�✓? �J {��'T1�i ��i l .(_0-31 ACKNOWLEDGEMENT:1 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 B ilding Official before being authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which plication is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# PW r /Iv�J v Owner/ or ed Agent Signature Date (Revised 1/72019)