2931 BROADWAY 2022-04-04 - Laserfiche WebLink

#1,100,. P LIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 NIIIITIL (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits ' PROJECT SITE INFORMATION PROJECT ADDRESS: .Z,g .< / R(,-c:c�.,4L1,, � SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU OMULTI-FAMILY IJCOMMERCIAL ❑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 FT IN HEIGHT STORMWATER DISCHARGES TO: 0 DRIVEWAY APRON/CURB CUT FT WIDE giCombined Sewer ❑ASPHALT/CONCRETE PAVING SF ❑Separated Storm Sewer ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF 0 Direct Discharge to Snohomish River or Puget Sound ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: CLEARING/GRADING/FILL/EXCAVATE Air CY CMMR2 Only 0 MR1-5 0 MR1-9 O CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: 6 SF O POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: 7 SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: 0 SF S 0;/ S _,. ,71/ ti S t ; .G,, , {- i � / d ; -�. = y (, CONTACT INFORMATION... .. OWNER I APPLICANT NAME: OWNER/APP. MAILING ADDRESS: STREET 5 I j<e_A.--elm, i CITY 'Ed STATE C'r 4 ZIP Z, ZO/ J OWNER/APP PHONE 2 760 9-3s OWNER/APP EMAIL *Required for Work in Public Right-of-Way CONTRACTOR NAME: S - 'C-ul,,,... E /?J--L-1 CONTRACTOR ADDRESS: 2 J (,1_, STREET 1 Ci(t l c= CITY / G/Le'Ace��.\._ STATE //OA ZIP <b---2z..i-a CONTRACTOR PHONE: 36 0 - 7/ 0: CONTRACTOR EMAIL: b ej1 - 5 q-/--u k.,..y,.,, -4 e-t CONTRACTOR LICENSE#(REQUIRED) EVERETT BUSINESS LICENSE#(REQUIRED) PRIMARY CONTACT: Id OWNER /APPLICANT ❑CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: G/L j. 7 0 'I 3 S 6 7-76-71;v6,J' )(6 n,ar0 14YA. CONTACT EMAIL: A As. v..„,, �,E;LiC�i rj ` -- kept„.., ACKNOWLEDGEMENT:I have rev wed this application and confirm the information contained herein is true andJcorrect. 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# �-✓ 7-S -1 l PW /907' Olt Owner/Authorized gen ignature Date (Revised 1/72019)