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mg PIOLIC 0 - S PE ' IT PaPLICATION CITY OF EVERETT PERMIT SERV ES 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON VEREIT(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION. PROJECT ADDRESS: ac)... _t MaiC11 �Ok"\,) Si k—,1 ---kt W Ps 1.sq, 2.0 • SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX DADU ❑MULTI-FAMILY ❑COMMERCIAL DINDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) DESCRIPTION OF SITE'WORK I RIHT G OF-WAtY,WK OR 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 0 Combined Sewer ASPHALT/CONCRETE PAVING SS C) SF c.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 CY MR2 Only 0 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: SF ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: • 9£ SF ADDITIONAL DESCRIPTION (AS NEEDED): Total New+Replaced: `5- ,.. SF CONT.ACTINFORMATION . , ,-._., , . ', ., OWNER I APPLICANT NAME: a.l �V 14\A/ t V O/1A ^�� OWNER/APP. MAILING ADDRESS: STREET D... 2 1 (` 1"1A� �`�1/\/ CITY QA STATE V V Pt- ZIP I S 2O7) OWNER/APP. PHONE: OWNER/APP. EMAIL: *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: 4 OWNER /APPLICANT 0 CONTRACTOR ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: I h CONTACT PHONE: �4-Ly 1 �1 LC ---1- 4% 4-Ci -01 coy./ 1 iO' AMi CONTACT EMAIL: OyS ftr I( IrklliN., c niA..OoQ / wt ' L. c;>o ACKNOWLEDGEMENT:I have revie d thi application and confirm the information contained'herein is true and c rrect. l/ork done pursuant to tH permit must comply with current federal, state, and l�llaw. The granting of a permit only authorizes approved work and no deviation 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# "----\ \Sokt,/ Z l PW . 7- 037 Owner/Authorized Agent Sig ature Date (Revised 4/15/2019)