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i PIOLIC WORKS PERMIT P&PLICATION CITY OF EVERETT PERMIT SER ICES EVERETT WASHINGTON 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1216 Broadway Avenue, Everett WA 98201 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY ❑✓ COMMERCIAL []INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, FIRE-APP, SS, ETC.) IF APPLICABLE: ❑ 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: DRAINAGE MITIGATION QUESTIONS: STORMWA TER DISCHARGES TO: ❑ FENCE IN ROW FT IN HEIGHT ❑✓ DRIVEWAY APRON / CURB CUT 26 FT WIDE ✓❑ Combined Sewer ❑✓ ASPHALT / CONCRETE PAVING 9,024 SF ❑ Separated Storm Sewer ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF ❑ Direct Discharge to Snohomish River or Puget Sound TRIGGERED REQUIREMENTS: ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑ CLEARING / GRADING / FILL / EXCAVATE CY ❑ MR2 Only ✓❑ MR1-5 ❑ MR1-9 QUANTITY OF PROPOSED HARD SURFACES: ❑ CUT/BORE IN PAVEMENT (PARALLEL) LF ❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF Proposed Roof Area: 0 SF ❑ POLE WORK / AERIAL / OVERLASH LF Proposed Hardscape: 0 SF ADDITIONAL DESCRIPTION (AS NEEDED): Total New + Replaced: 9,024 SF Install asphalt pavement to replaced demolished building. Construct two driveway ramps and replaced pavement to accomodate ramp grading elevations. Replace sidewalk within ROW. Install asphalt seal coat and pavement markinqs. CONTACT INFORMATION OWNER / APPLICANT NAME: Jerry Osborn, Osborn Architects Inc PS OWNER / APP. MAILING ADDRESS: STREET 1011 SW Klickitat Way #208 CITY Seattle STATE WA zip 98134 OWNER / APP. PHONE: 206.920.6348 OWNER / APP. EMAIL: josborn@oaips.com *Required for Work in Public Right -of -Way CONTRACTOR NAME: TBD CONTRACTOR ADDRESS: STREET CITY f , STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): 14./� LA EVERETT BUSINESS LICENSE #(REQUIRED): 9 1' d 4/ PRIMARY CONTACT: ❑ OWNER / APPLICANT ❑ CONTRACTOR W71 OTHER (Architect, Engineer, Etc.) CONTACT NAME: Jerry Osborn CONTACT PHONE: 206.920.6348 CONTACT EMAIL: josborn@oaips.com ACKNOWLEDGEMENT: 1 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 1 am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only �/� PERMIT # ' Z 7 2 2- P W 2,1,0 r� 0 O ne Auth Ized Agent Signature Dat (Revised 1172019)