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• <br /> . PUBLIC WORKS PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 FAX 425-257-8857 (E)everetteps@everettwa.gov 1 https://everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:10312 EVERGREEN WAY,EVERETT,98204 <br /> SITE WORK FOR PROJECT TYPE: EISFR-DETACHED OTOWNHOUSE EJDUPLEX EIADU OMULTI-FAMILY DCOMMERCIAL [INDUSTRIAL <br /> IF APPLICABLE: Li LAND USE PROJECT#(SEPA,PRE-APP,SS,ETC.)BSP20-005,PREAPP 20-046 <br /> IF APPLICABLE: El FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# <br /> UTILITY COMPANY'S NAME&JOB#: JOB# <br /> DESCRIPTION OF SITE WORK/RIGHT-OF-WAY WORK <br /> FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: <br /> [7]FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: <br /> E]DRIVEWAY APRON/CURB CUT 25&36 FT WIDE Ei Combined Sewer <br /> El ASPHALT/CONCRETE PAVING 56632 SF WI Separated Storm Sewer <br /> E RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF El Direct Discharge to Snohomish River or Puget Sound <br /> El RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: <br /> El CLEARING/GRADING/FILL/EXCAVATE 5295 CY El MR2 Only El MR1-5 171 MR1-9 <br /> ILI CUT/BORE IN PAVEMENT(PARALLEL) 410 LF QUANTITY OF PROPOSED HARD SURFACES: <br /> 1.74 CUT/BORE IN PAVEMENT(NON-PARALLEL) 10 LF Proposed Roof Area:7693 SF <br /> E POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape:56632 <br /> SF <br /> ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced:64'325 SF <br /> Proposed site clearing, grading, drainage, utilities and street improvevement work associated with <br /> development of a new car wash, drive-thru restaurant, and coffee drive-thru. <br /> Building permit will be filed separately. Separate PW permit for signal, street lighting & traffic loops. <br /> CONTACT INFORMATION <br /> OWNER/APPLICANT NAME:Serj Development LLC (Rune Harkestad,member) <br /> OWNER/APP. MAILING ADDRESS: STREET 1500 East Katella Avenue#5 <br /> CITY Orange ZIP STATE CA 92867 <br /> OWNER I APP.PHONE:(425)477-8556 OWNER I APP.EMAIL:rune.harkestad@kidder.com <br /> *Required for Work in Public Right-of-Way <br /> CONTRACTOR NAME: Kugel Construction (Adam Kugel, owner) <br /> CONTRACTOR ADDRESS: STRRET 1722 Bishop Road <br /> crry Chehalis STATE WA ip • 32 <br /> CONTRACTOR PHONE:(360)219-3555 CONTRACTOR EMAIL:adam@kugelconstruction.com <br /> CONTRACTOR LICENSE#(REQUIRED):Kuger971 D4 EVERETT BUSINESS LICENSE#(REs IRED)76(64-7--co <br /> PRIMARY CONTACT: El OWNER /APPLICANT El CONTRACTOR Ei OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: (206)795-9023 <br /> Terraforma Design Group,Inc-Pedro DeGuzman,PE <br /> CONTACT EMAIL:pedro@terraformadesigngroup.com <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must <br /> 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 <br /> 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 <br /> perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 12 3 PERMIT# <br /> /29/21 <br /> PW Z10-1- oit <br /> Owner/Author Agent ignat e Date (Revised 1/72019) <br />