9131 MEADOW WAY 2022-06-29 - Laserfiche WebLink

PLIC 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.INtFORMATION:_ . PROJECT ADDRESS: t t 3 )te.040 cry,y �V SITE WORK FOR PROJECT TYPE: 4SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) DESCRIPTION QF $1TE.INORK lRiGH1`tfF=NAY W1RK 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 Rif ASPHALT/CONCRETE PAVING 6100 SF 13-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 Ii'((AAR2 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: SF ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: 4o0 Sr' SF OWNER/APPLICANT NAME: e5 LACASk,n� OWNER/APP. MAILING ADDRESS: STREET 9 t 3 k Jkleaile w(IA/ �1 CITY STATE v„.) ZIP OWNER/APP.PHONE: OWNER/APP. EMAIL: ., >,:._....<r ....... ......:..:..�sais ._-. »' ,.,........,... ..x.....:«.,• ,-,..,....x�,>. ..... --:� .. ._�.,�..�.- ,...�,,..v. >....,..�.�«,x ....mN ....�.rew,.�a. _.o.. ...._...,�«.,.. mw x a *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) a PRIMARY CONTACT: 'ROWNER /APPLICANT 0 CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTA AME: CONTACT PHONE: 41?6 9 Lie-O t (o O R� k\�n� CONTACT EMAIL: 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 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 ade,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# • �/1� /k,e, PW 2003 .0o Co Owner/Authorized Agent Signature Date (Revised 4/15/2019)