2910 23RD ST 2022-08-25 - Laserfiche WebLink

in PIIC WORKS PERMIT A.'" !CATION CITY OF EVERETT PERMIT SERVICE.. 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 INFORMATION ._ PROJECT ADDRESS: 1.S 1O `1,3.1 51 / (--.\f,L, 4,-k\ CVA SITE WORK FOR PROJECT TYPE: SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX DADU ❑MULTI-FAMILY DCOMMERCIAL DINDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) DESCRIPTION OF SITE WORK I 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: A DRIVEWAY APRON/CURB CUT i 2- FT WIDE rei Combined Sewer .ASPHALT/CONCRETE PAVING 4- CC' SF 0 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 aMR2 Only ❑ MR1-5 0 MR1-9 ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: 93 SF ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: 441),, SF z ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: cf cv SF CONTACT:INFOR ATION.. :,; - OWNER/APPLICANT NAME: Ey ,` L;-{.:, OWNER/APP. MAILING ADDRESS: STREET -1-.61 1 0 j,"4 0 c J CITY E`J i'eG\ STATE �/A ZIP `C�1-01 OWNER/APP. PHONE: -3 i,0 9 13 Jv S Li OWNER/APP EMAIL th.c,yOA!r1"./ 414•L'I L 0 *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: p.OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: ACKNOWLEDGEMENT:I 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 made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. I ' City of Everett Official Use Only 4- ,2 PERMIT# , IA, tO/ 1L(! 1ci PW ilio - o28 Owner/Authorized Agent Signature Date (Revised 4/15/2019)