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gm <br /> PVILIC WORKS PERMIT AFILICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> HH3�It . 1 <br /> PROJECT ADDRESS:2901 Lowell Klver Road, Everett,WA SiktsCejUllWI DSYLt7040100 <br /> SITE WORK FOR PROJECT TYPE: ESFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> IF APPLICABLE: ID LAND USE PROJECT#(SEPA,PRE-APP,SS,ETC.)Shoreline Substaintial Development Permit&Landscape Modification <br /> IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# <br /> UTILITY COMPANY'S NAME&JOB#: JOB# <br /> DESCRIPTION OF SITE WORK/ RIGHT-OF-WAY WORK <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 196 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 See below CY ❑MR2 Only Q MR1-5 El MR1-9 <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) <br /> LF Proposed Roof Area: SF <br /> ❑POLE WORK/AERIAL/OVERLASH <br /> LF Proposed Hardscape:196 . SF <br /> ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced:196 SF <br /> Construction of a 0.85 acre off-leash dog park. Install approximately 1,200 LF of 4' high wood post and <br /> and rail fence with wooven wire fabric. Install gates and one(1) 14'x14'(196 sq.ft.)concrete pad. <br /> Remove 0.70 acres non-native and invasive shrub vegetation,till and seed with native grasses. Plant native trees. <br /> CONTACT INFORMATION <br /> OWNER I APPLICANT NAME:Robert Hillmann-City of Everett Parks and Community Services <br /> OWNER/APP. MAILING ADDRESS: sTREEr802 E Mukilteo Blvd, <br /> CITY Everett STATE WA ZIP 98203 <br /> OWNER/APP.PHONE:425-257-8376 (OWNER/APP. EMAIL:rhillmann@everettwa.gov <br /> *Required for Work in Public Right-of-Way <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: (CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 'EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE:425-268-8495 <br /> Robert Hillmann CONTACT EMAIL:rhillmann@eVerettwa.gov <br /> ACKNOWLEDGEMENT.*I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must <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.lam the owner,or lam 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 /> Robert Hillmann De9^edbyRobert Hillmann <br /> ! Date:2020.t2.23 o4-0'00' PW 2Ao I'OW <br /> Owner/Authorized Agent Signature Date (Revised 1/72019) <br /> JY\AO lq-0024 <br />