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P I UUCWORKS PEF \A 0T E PUCATION CITY OF EVERETT PERMIT SERVICES 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 `:;' P.ROJEGT-SI 'E.I 1F' RMAtJOJt PROJECT ADDRESS: 4 S3 (.0 C a— .1 .+A M£.% —TD:z- SITE WORK FOR PROJECT TYPE: I5SFR-DETACHED ❑TOWNHOUSE ODUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL [INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) . ,.__,. .. . :::;. ._":.. DESCRIPTION<OF;SITE WOR11;1_:RIO IT OF..WACOVOitic .....__ .._ .: : a... ... 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 ❑Combined Sewer VIASPHALT/CONCRETE PAVING f ti E,0 p 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 FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑CLEARING/GRADING/FILL/EXCAVATE CY fitIVIR2 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: !,BOO SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: I, gG U SF 1-'avE- Co4C..• ;) .�. 4 OWNER/APPLICANT NAME: OWNER/APP. MAILING ADDRESS: STREET CITY STATE ZIP OWNER/APP.PHONE: OWNER/APP.EMAIL: *Required for Work in Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): S PRIMARY CONTACT: ❑OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: 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 application is made,and I comply with the State Contractors Law 18.27 ROW and 296.200A WAC. City of Everett Official Use Only PERMIT# )ani*Q--; 22__ PW Owner/Authorized Agent Signature Date (Revised 4/15/2019)