5125 SEAHURST AVE 2022-12-06 - Laserfiche WebLink

PUBLIC WORKS PERMIT AAPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 0477. (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION'' PROJECT ADDRESS: (0 Li: S S(ZS Se,c,A1.uRj NA'e- cte— , z 0� SITE WORK FOR PROJECT TYPE: OSFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# _> DESCRIPTION OF SITE WORK./ R1GHT.OF-1NAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: 'Q'TJRIVEWAY APRON/CURB CUT Le 5 FT WIDE ❑Combined Sewer ASPHALT/CONCRETE PAVING {-) 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: El CLEARING/GRADING/FILL/EXCAVATE vL' CY 0 MR2 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: SF CONTACT'INIFORMATI ON • OWNER/APPLICANT NAME: ?,cA, t(cG•1 OWNER/APP. MAILING ADDRESS: STREET `AA dl. (,2.1-1 }" S r• S L. CITY C.'e--k i, STATE L'�� 'ZIP"L LO OWNER/APP. PHONE: LI2,S•Z39 1'I2 si OWNER/APP.EMAIL: IOG1� 44n C(^\1 SCE co .� ..� *Required for Work in Public Right-of-Way CONTRACTORQ �I D NAME: Tr ? 0 'A-L. ) S.(,(- Z'jt� - .h 1D'n CONTRACTOR ADDRESS: STREET �('C.C,f3t el \ \ ` CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(I3E6UIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: < c OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: L- 7 - 23 -o621 ZpG�`49�J� CONTACT EMAIL: \--c) u � �h ( SL�N ,Cam 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 applic " n is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# 1 -ig PW bCv--�Z� Owner/A thorized Agent Signature Date (Revised 1/72019)