6520 ELLIOTT WAY 2023-05-11 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPL. 0 CITY OF EVERETT PERMIT SERVICES �� EV E R E T T SUBMITTAL INSTRUCTIONS:Email application&submittal documents to Perm itServlces@everettwa.gc drop offat 3200 Cedar Street 2nd Flo I p Box WASHINGTON CONTACT INFORMATION:(P)425-257-88101(E)PermitServices@everet ov I IIIWA�erWa.c(Qplrmlts FbAMOIF""' J. CT SITEIN PROJECT ADDRESS: ci �n Permit Services SITE WORK FOR PROJECT TYPE:-'ASFR-DETACHED OTOWNHOUSE DDUPLEX 11ADU OMULTI-FAMILY 000MMERCIAL DINDUSTRIAL IF APPLICABLE: El LAND USE PIROJECT#(SEPA,PRE-APP,SS, ETC.) IF APPLICABLE: []FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB M JOB M 'DESCRIPTION OF'SITE WdlikIl IRidN*.0P*A*T'WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: [FENCE IN ROW /-'' lzoF� fl .�CAO FT IN HEIGHT STORMWA TER DISCHARGES TO: 0 DRIVEWAY APRON I CURB CUT FT WIDE [3 Combined Sewer El ASPHALT I CONCRETE PAVING SF 13 Separated Storm Sewer 0 RETAINING WALL I ROCKERY IN RIGHT-OF-WAY LF 13 Direct Discharge to Snohomish River or Puget Sound ❑ RETAINING WALL I ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑CLEARING I GRADING I FILL I EXCAVATE _CY 13MR2Only 13MRI-5 13MR1-9 El CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: El CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF 0 POLE WORK I AERIAL I OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): ITotal New+Replaced: SF OWNER/APPLICANT NAME: z— OWNER I APP. MAILING ADDRESS: STREET c1Ty STATE ZIP OWNER I APP.PHONE: if)WMFR I APP.EMAIL: *Required for Work in Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: 1CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): 1EVERETT BUSINESS LICENSE#(REQUIRED):- PRIMARY CONTACT: El OWNER /APPLICANT ❑CONTRACTOR El OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: ICONTACT 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./am the owner,or I am authorized by the owner of this property to perform the work for which application is made,and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# "\A NL��M� 'R IPW Owner/Authorized Agent Signature (Y Date (Revised 412112022)