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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 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I https://everettwa.gov/permits
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<br /> ., . .PROJEctioTE:ItNFORMA' i(l . . . ., .. . ..
<br /> PROJECT ADDRESS: ).� L)ejt eVt-1 T)/ A i1 L G L,c'-'c' r WA- '82(.-Y
<br /> SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX DADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL
<br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.)
<br /> : ,, • DESCRIPTION OF***011110 16 WAti i ORK -anY'V w'z,:::;;.:•'
<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 FT WIDE 0 Combined Sewer
<br /> ❑ASPHALT/CONCRETE PAVING SF 0 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 CY ❑ MR2 Only ❑ 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: SF
<br /> ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF
<br /> ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: SF
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<br /> OWNER/APPLICANT NAME: re-Ok C✓'1 ✓e I'r 6 I
<br /> OWNER/APP. MAILING ADDRESS: STREET I2 Uti q_A)1-C _ +y 4-iJC--
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<br /> OWNER/APP. PHONE: W2-r J 3 C - 0?29 OWNER/APP. EMAIL:
<br /> *Required for Work in Public Right-of-Way
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<br /> CONTRACTOR NAME: z-y+b C✓ l &Col'
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<br /> CONTRACTOR ADDRESS: STREET /Z l,✓ :. .A3-}—C.'Cc 'r`/ A'iQ
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<br /> CONTRACTOR PHONE: qZ,S -S3' ' `>>1`, CONTRACTOR EMAIL: l' s0v, A) '6(--- Li- / i ,
<br /> CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED):
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<br /> PRIMARY CONTACT: 0 OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.)
<br /> CONTACT NAME: CONTACT PHONE: 1I2 5 --- S.3 t) -0227
<br /> Rs)tf`r-- [✓er,,J CONTACT EMAIL: j'2Q.4JAi. 6C.,LL-C, f'1C�i/Lt& / e-(7""--)
<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 an circum I stance, 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 comp) S e 1$27 RCW and 296.200A WAC.
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<br /> ►.. I City of Everett Official Use Only
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<br /> PERMIT#
<br /> MAR 232023 PW ''' -'m3 - 0 { -1
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
<br /> CITY OF EVERETT
<br /> Permit Services
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