419 ROCKEFELLER AVE 2023-05-31 - Laserfiche WebLink

isis POBLIC WORKS PERMIT iPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I https://everettwa.gov/permits ll ]] PROJECT SITE INFORMATION PROJECT ADDRESS: LI I R 0 0ke 1/1-QJ' O/G Ld� 8 t�' SITE WORK FOR PROJECT TYPE: 4SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX EADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: J LAND USE PROJECT#(SEPA, PRE-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: ❑FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: ❑DRIVEWAY APRON/CURB CUT FT WIDE ❑ Combined Sewer ❑ASPHALT/CONCRETE PAVING SF ❑ Separated Storm Sewer ❑ RETAINING WALL/ ROCKERY IN RIGHT-OF-WAY LF ❑ Direct Discharge to Snohomish River or Puget Sound ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ( CLEARING/GRADING/FILL/EXCAVATE 2.t$ 0 CY ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: SF , CONTACT INFORMATION OWNER/APPLICANT NAME: Jo,C14 Biro+hers j rhef OWNER/APP. MAILING ADDRESS: STREET 3C(2 2. e k k tiC CITY fnQ44 30 t ItC STATE .16^� ZIP 2715 OWNER/APP. PHONE:9 2�=Zero- 2-4 a 9 _OWNER/APP. EMAIL: Soe\Qr(to.tk 1Dr 0+-W n'. c 0"4 `Required for Work in Public Right-of-Way CONTRACTOR NAME: IA'4u t' efo4-h'f3 140 r -e1 CONTRACTOR ADDRESS: STREET 3 CI 2 2 S'7 4-JA A-t/L. N C.- CITY Ar\C-Nr‘lS U I ' "C STATE u,..)p� ZIP 78?-43 CONTRACTOR PHONE: 9 2 " 2e0-2'I? 9 ICONTRACTOREMAIL: j Ce ` 111 tt c&CCU lor o+he ,I'!. ( O/t CONTRACTOR LICENSE#(REQUIRED):HCXOCk 0 1 0 1 2 p 2. EVERETT BUSINESS LICENSE#(REQUIRED):3 96D 7 PRIMARY CONTACT: OWNER /APPLICANT ❑ CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: %A 25- 2 er 0 — 2 y 2 p' 5 * l [4ct a k CONTACT EMAIL: J 3 Oe l 4 4 the ljr o A-1nte cr. <0✓-1 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 I am authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT 6 ,lo - 2 a PW bpi-005 Owne u orized Agent Signa Date (Revised 1/72019)