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Ems P, JUUC `''t;ORKS PE IT A PUC1kTON CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (EI ',1)�everetteps@everettwa.gov I https://everettwa.gov/permits z `�" n..y� f /►Tip G u0 AtIO PROJECT ADDRESS: 7T 01 t & • $ee .44 sJ • SITE WORK FOR PROJECT TYPE: SFR-DETACHED DTOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) :: ... i :: ,DESCRIPTION<OF:SITE:WORK I RIGHT-OF`WA 'WORK . ... f. L v. •. FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑ FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: B DRIVEWAY APRON/CURB CUT 146 FT WIDE ❑Combined Sewer LIB ASPHALT/CONCRETE PAVING i a SF E Separated Storm Sewer ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ®Direct Discharge to Snohomish River or Puget Sound ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: EI LEARING/GRADING/FILL/EXCAVATE 106 G�f ZD 511 CY ❑MR2 Only 0 MR1-5 0 MR1-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: SF 413i.f w e I9 / 3 c 4 basins. I 5-6410 co�tn aa/ I wit-kr me box, I Wa V' 5e,tVict; I Ate- 1 11`J Wick—Sid>✓cvaik / I Type-$ ,4--4-Cvl`b �4/ � i 7D/Gvrh�' i- T „ - R ` F +R Y _-VitAi itAttahri- �i ■olt Mw zEg tNY xn _ OWNER/APPLICANT NAME: N 1(Al4, . f -1 5,141 Tk OWNER/APP. MAILING ADDRESS: STREET f Gr Box /Z/�1C a/' CITY K 1 U IN/11). STATE IAJ4 ZIFTOF3 OWNER/APP. PHONE: /1 I"1S�j351 OWNER/APP.EMAIL: j treidie Q $14//i -0014 -. k ...� L .Yam....c..n x ., wwp`�e,»+.wxxua++s.xa ,.-a+�.»n3.«.rtr»vsawk.x.•.�.•: *Required for Work in Public Right-of-Way f / CONTRACTOR NAME: Ci'l i)(5.4 II S 'o INIe.5)LL-Z CONTRACTOR ADDRESS: /I STREET/\e c,pox A( CITY/ 4 Aj 4 kg STATE VA- I ZIP180 CONTRACTOR PHONE: 5 I i :-536-6 CONTRACTOR EMAIL: I f e NI r1.e 01iv14l /i _in/- CONTRACTOR LICENSE#(REQUIRED): L}4e--yS(4 i-g j•5>IJ EVERETT BUSINESS LICENSE#(REQUIRED):54311 PRIMARY CONTACT: ❑OWNER /APPLICANT BreONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: G,26---pl 3t,—c35-�v I 1 `�DYn I 1 A CONTACT EMAIL: j.. '-tm e® i Jf 49 ill ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein iS true and correct.'kork 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.lam 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. City of Everett Official Use Only PERMIT#e/--- zed ,,,�// Pw 2t12-0360 Owner/Authorized Agent Signature Date (Revised 4/15/2019)