8015 BROADWAY CHICKA LATTE BEAUTIFUL COFFEE 2023-02-15

• I PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 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 INFORMATIO PROJECT ADDRESS: $ Q I 31C'i ( c ,12 it - (JCR c76-fC)_ SITE WORK FOR PROJECT TYPE: ❑SFR-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 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: ❑DRIVEWAY APRON/CURB CUT FT WIDE ❑C mbined Sewer ❑ASPHALT/CONCRETE PAVING SF 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 1 FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑CLEARING/GRADING/FILL/EXCAVATE 4 CY 7MR2 and ❑MR1-5 ❑MR1-9_ LI CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: C SF El POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: SF 5 (2 A C'( t:.dr. =.0 t 1 .1��f' —--�` S L,pt iz _74 c&t . CONTACT INFORMATIONN OWNER I APPLICANT NAME: y��-�� " ..�" A OWNER/APP. MAIUNG ADDRESS: STREET / (7. `/ ( I ( CITY ) C4 l `( STATE ZIP1'tf I OWNER/APP.PHONE:( <1 .S. f OWNER/APP.EMAIL: Ylf- *Required for Work in Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR UCENSE#(REQUIRED): EVERETT BUSINESS UCENSE#(REQUIRED): PRIMARY CONTACT: rE<WNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: ( .(��) <5 116 (,� (zl /u,� CONTACT EMAIL: ) % i) 1 (S.`>, �lA..> �!I/— C I c-1vL.tc`L1 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 fof 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# PW Z104-a 1,66 Owner/ thorized Age ature Date (Revised 1/72019)