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P3LIC WORKS PERMIT 4OPLICATION <br /> CITY OF EVERETT PERMIT SE vICES <br /> EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:7010 COLBY AVE, EVERETT, WA 98203 <br /> SITE WORK FOR PROJECT TYPE: QSFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ECOMMERCIAL [INDUSTRIAL <br /> IF APPLICABLE: E LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.)SS18-005 PREAPP18-012 - PWPN:1202-2018-005 <br /> IF APPLICABLE: ❑ 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 /> ❑FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: <br /> ❑✓ DRIVEWAY APRON/CURB CUT 20 FT WIDE LI Combined Sewer <br /> ❑✓ ASPHALT/CONCRETE PAVING 780 SF ❑✓ Separated Storm Sewer <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ Direct Discharge to Snohomish River or Puget Sound <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: <br /> ❑CLEARING/GRADING/FILL/EXCAVATE 890 CY ❑ MR2 Only EJ MR1-5 ✓❑ MR1-9 <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area:.1 3,500 SF <br /> ❑POLE WORK/AERIAL /OVERLASH LF Proposed Hardscape:6,000 SF <br /> ADDITIONAL DESCRIPTION (AS NEEDED): Total New+Replaced:19,500 SF <br /> 5 LOT SHORT PLAT WITH SINGLE PRIVATE ACCESS ROAD OFF OF COLBY. ALL EXISTING <br /> IMPROVEMENTS TO BE REMOVED. DRAINAGE MITIGATION A COMBINATION OF INFILTRATION <br /> AND DETENTION SYSTEMS. <br /> CONTACT INFORMATION <br /> OWNER/APPLICANT NAME:PAUL KORENOVSKY <br /> OWNER/APP. MAILING ADDRESS: sTREET4231 SOUTH 3RD AVE <br /> CITY EVERETT STATE WA ZIP 98203 <br /> OWNER/APP. PHONE: OWNER/APP. EMAIL:paUl@allledwaterproff.COm <br /> `Required for Work in Public Right-of-Way <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: El OWNER /APPLICANT ❑ CONTRACTOR ❑✓ OTHER(Architect, Engineer, Etc.) CIVIL ENGINEER <br /> CONTACT NAME: CONTACT PHONE:425.903.4852 <br /> JOSEPH SMEBY, P.E. CONTACT EMAIL:joe@omega-eng.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 /> oir PERMIT# <br /> IP <br /> P W o 3S <br /> 0 r Allit Agent Signature Date (Revised 1/72019) <br />