2602 81ST PL SE 2023-05-10 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL INSTRUCTIONS r. I!- d>;ivuwif of li sub—ttai documents to PermitServicesaevefettwa gov or drop off at 3200 C:eaa' .--:Ic :. u I Ioor Drop Box WASH INC. TON CONTACT INFORMATION �P,4" -gy,�EPe,mrtSe- ces�everettwagovI(W)everettwagowperml5 PROJECT SITE INFORMATION PROJECT ADDRESS:2602 81ST PL SE SITE WORK FOR PROJECT TYPE: OSFk-uLTACHED ❑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 $1 UTILITY COMPANY'S NAME & JOB #: JOB = DESCRIPTION OF SITE WORK I RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON / CURB CUT FT WIDE 9 ASPHALT / CONCRETE PAVING 3000 SF 8 RETAINING WALL ROCKERY IN RIGHT-OF-WAY 169 LF ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT 9 CLEARING / GRADING / FILL / EXCAVATE 10 CY ❑ CUT/BORE IN PAVEMENT (PARALLEL) LF ❑ CUT;BORE IN PAVEMENT (NON -PARALLEL) LF ❑ POLE WORK i AERIAL / OVERLASH LF ADDITIONAL DESCRIPTION (AS NEEDED)- DRAINAGE MITIGATION QUESTIONS: STORMWATER DISCHARGES TO: ❑ Combined Sewer E Separated Storm Sewer ❑ Direct Discharge to Snohomish River or Puget Sound TRIGGERED REQUIREMENTS: 0 MR2 Only ❑ MR1-5 ❑ MRt-9 QUANTITY OF PROPOSED HARD SURFACE Proposed Roof Area _ SF Proposed Hardscape SF Taa. New • Replaced SF 1500 SF of new paver surface and 1500 SF of concrete replaced by pavers with 169 LF of 2 FT high retaining wall. CONTACT INFORMATION OWNER / APPLICANT NAME. Galina and Eli Warner OWNER ) APP MAILING ADDRESS IIEE12602 81ST PL SE cf-• EVERETT WA 98203 OWNER / APP- PHONE. 8016805942 OWNER,' APP EMAIL. EWARNER9@YAHOO.COM 'Required for Work in Public Rignl-of-Way CONTRACTOR NAME: NIEVEZ GONZALEZ CONTRACTOR ADDRESS: STREET 11000 16TH AVE SE CIT. EVERETT WA r,, 98208 CONTRACTOR PHONE 4255283277 CONTRACTOR EMAIL - CONTRACTOR LICENSE MREQUIRED RAINCCF819D2 EVERETT BUSINESS LICENSE il(REQUIRED; UB1604398292 PRIMARY CONTACT: ❑ OWNER r APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect Engineer. Etc ; CONTACT NAME N I EVEZ GONZALEZ CONTACT PHONE: 4255283277 CONTACT EMAIL. ACKNOWLEDGEMENT i have rewevied this appitcabcn ana 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 Budding Official before being authorized under any circumstance I am the owner or 1 am authorized by the owner of this property to perform the work for which application is made and I comply with the State Co ractors La/18 27 RCW and 296 200A WAC ^ r "rry of Everett Official Use Only IPVV Owner/Authorized Agent Signature Dat (Kevised 4r2712022)