421 ROCKEFELLER AVE 2023-05-31 - Laserfiche WebLink

PILIC WORKS PERMIT AOLICATION OERET EVERETT 3200CITY CEDAR F EV STREETT, EVERETTPERMIT , WA SERVICES 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: '� P_ocke 4e tier A•ve (Ltc /01 ii SITE WORK FOR PROJECT TYPE: ®SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ['COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: I-1 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.fj O CY ❑MR2 Only ❑MR1-5 ❑ MR1-9 Li CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARDA SURFACES: LiCUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: 3 1 S/ SF ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: 13 ZC SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: /'1 1 7 SF N e1/4,-) Si;Z CONTACT INFORMATION OWNER/APPLICANT NAME: t-IU.VItk fa•\hecs -p IY 'S / 7-0 e 1 (•4 A Ok C 1< OWNER/APP. MAILING ADDRESS: STREET 39 Z, A Le CITY no,o, STATE (j.4 ¶ Z S ZIP v 0 OWNER/APP. PHONE: 92,S-no--Z 2 1 OWNER/APP. EMAIL: Joele i L nctuk br0 k-ker1 (0 IVI *Required for Work in Public Right-of-Way 1 1- CONTRACTOR NAME: I, (x.C;k 13 ro�kiz O r'e c CONTRACTOR ADDRESS: STREET 7C4 e O S c,hove CITY STATE ZIP CONTRACTOR PHONE: `-125- Leto -2't Li CONTRACTOR EMAIL: ' oe h c ton)t7+'_)4-lt r Cv►M CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): GS 3 96, 7 PRIMARY CONTACT: el OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: Li 2 5 - Z 1®-- 2 y a 7 7500 E46tock e 1e h COX h CONTACT EMAIL: J'U �C d'c•aer7 ,n1 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 Buildi 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 applicati is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT G — 1"1-ZQ 20 Pw Lee 00( Owne/Aut rized Agent Signa Date (Revised 1/72019)