4937 EVERGREEN WAY QFC FUELING STATION 2023-06-13

N PIISLIC WORKS PERMIT LICATION CITY OF EVERETT PERMIT SERV FES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 4919 Evergreen Way, Everett, WA 98201 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) SEP20-017 IF APPLICABLE: F] FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT # UTILITY COMPANY'S NAME & JOB #: JOB # DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: ❑ FENCE IN ROW ❑ DRIVEWAY APRON / CURB CUT O ASPHALT / CONCRETE PAVING 22,285 ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT CLEARING / GRADING / FILL / EXCAVATE 1,700 ❑ CUT/BORE IN PAVEMENT (PARALLEL) ❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) ❑ POLE WORK / AERIAL / OVERLASH ADDITIONAL DESCRIPTION (AS NEEDED): FT IN HEIGHT FT WIDE SF LF FT TOTAL HEIGHT CY LF LF LF DRAINAGE MITIGATION QUESTIONS: STORMWA TER DISCHARGES TO: ® Combined Sewer ❑ Separated Storm Sewer ❑ Direct Discharge to Snohomish River or Puget Sound TRIGGERED REQUIREMENTS: n MR2 Only ❑ MR1-5 (-1 MR1-9 QUANTITY OF PROPOSED HARD SURFACES: Proposed Roof Area: 4,128 SF Proposed Hardscape: 18,157 SF Total New + Replaced: 22,285 SF CONTACT INFORMATION OWNER / APPLICANT NAME: Claremont Village Station, LLC OWNER / APP. MAILING ADDRESS: STREET 11501 Northlake Drive CITY Cincinnati STATE OH zip 45249 OWNER / APP. PHONE: (206) 808-0303 OWNER / APP. EMAIL: Brian.peterson@kroger.com `Required for Work in Public Right -of -Way CONTRACTOR NAME: To be determined CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: [CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: ❑ OWNER / APPLICANT ❑ CONTRACTOR I-N OTHER (Architect, Engineer, Etc.) Barghausen Cons. Engrs. CONTACT NAME: Joel Howitt CONTACT PHONE: (425) 251-6222 CONTACT EMAIL: jhowitt@barghausen.com ACKNOWLEDGEMENT. / 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. l 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 Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only �PERMIT # 8/24/2021 PW Z 11 1 O Owner/Authorized Agent Signature Date (Revised 1172019)