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P!BLIC WORKS PERMIT APPLICATION <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 /> PROJECT ADDRESS:1502 Wall Street <br /> SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY EICOMMERCIAL ❑INDUSTRIAL <br /> IF APPLICABLE: Li LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <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 /> n FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: <br /> ❑DRIVEWAY APRON/CURB CUT FT WIDE ❑✓ Combined Sewer <br /> ❑ASPHALT/CONCRETE PAVING 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/EXCAVATE CY ❑ MR2 Only ❑ MR1-5 MR1-9 <br /> Li CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area 11,953 SF <br /> ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape:none SF <br /> ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: 11,953 SF <br /> New Building addition will fill the entire site. Connections for Water, Storm and Sanitary Sewer are <br /> proposed but may be incorporated into existing services <br /> CONTACT INFORMATION <br /> OWNER/APPLICANT NAME: Imagine Children's Museum- Nancy Johnson <br /> OWNER/APP. MAILING ADDRESS: STREET 1502 Wall Street <br /> CITY Everett STATE WA ZIP 98201 <br /> OWNER/APP. PHONE:425.258.1006 ext. 1013 OWNER/APP. EMAIL:nancyj©imaginecm.org <br /> *Required for Work in Public Right-of-Way <br /> CONTRACTOR NAME: Gaffney Construction <br /> CONTRACTOR ADDRESS: STREEI 8105 Broadway <br /> CITY Everett STATE WA ZIP 98203 <br /> CONTRACTOR PHONE:425.355.5500 CONTRACTOR EMAIL:joe@gaffneyconstruction.com <br /> CONTRACTOR LICENSE#(REQUIRED):GAFFNCI104K3 EVERETT BUSINESS LICENSE#(REQUIRED): 012160 <br /> PRIMARY CONTACT: ❑OWNER /APPLICANT ❑CONTRACTOR ❑✓ OTHER(Architect, Engineer, Etc.) Architect <br /> CONTACT NAME: CONTACT PHONE:425.252.2153 <br /> Adam Clark 2812 architecture CONTACT EMAIL:adam@2812architecture.com <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. I am the owner,or I am authorized by the owner of this property to <br /> perform the work for which application is made,and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> C73207 June 19 PW - 02. 0 <br /> Owner/Authorized Agent Signature Date (Revised 1/72019) 1 <br />