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POLIC WORKS PERMIT *PLICATION <br />CITY OF EVERETT PERMIT SERVICES n r <br />EVERETT <br />3200 CEDAR STREET, EVERETT, WA:98201 + �� <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https://everettwa.gov/permits <br />PROJECT ADDRESS: U ( f,<' >4 C Pl L/ T 5 RUC IZc� TT^D <br />SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY ❑COMMERCIAL' OINDUSTRIAL <br />IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC. <br />DESCR PTIGN QF S1TE:IN A F RIGHT 01:MAY;iNGRK . <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: <br />❑ FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: <br />DRIVEWAY APRON / CURB CUT FT WIDE ❑ Combined Sewer <br />ASPHALT / CONCRETE PAVING 3 D O SF ❑ Separated Storm Sewer <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF ❑ Direct Discharge to Snohomish River or Puget Sound <br />❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: <br />❑ CLEARING / GRADING / FILL I EXCAVATE CY ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 <br />❑ CUT/BORE IN PAVEMENT (PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF Proposed Roof Area: SF <br />❑ POLE WORK / AERIAL / OVERLASH LF Proposed Hardscape: SF <br />4DDITIONAL DESCRIPTION (AS NEEDED): Total New + Replaced: SF <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit mast <br />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 <br />authorized in writing from the Building Official before being authorized under any circumstance. 1 am the owner, or I am authorized by the owner of this property to <br />perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />1- zz-20zo PW <br />r)wnpr/Authnri7ed aent Signature Date (Revised 411512019) <br />