433 ROCKEFELLER AVE 2023-06-21 - Laserfiche WebLink

PS3LIC WORKS PERMIT APPLICATION OERET EVERETT 3200CITY CEDAR F EV STREETT, EVERETTPERMIT , WASERVICES 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps©everettwa.gov I https://everettwa.gov/permits Y.)-} PROJECT SITE INFORMATION PROJECT ADDRESS: LiR o cke 4e t� -V& (..,6,17c IL 4 ( SITE WORK FOR PROJECT TYPE: OSFR-DETACHED LITOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL [INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: H 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 3 7 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 s dA'e w or Cc -c-cr re ' - S F. CONTACT INFORMATION OWNER I APPLICANT NAME: ktu.I4 B ro+v rr5 OWNER/APP. MAILING ADDRESS: STREET 3922, 1 +is CAlia CITY /11 W 3 J I e STATE ZIP 9N8 0?elOWNER/APP. PHONE:9 2-c Zero- 2 f 2 9 OWNER/APP.EMAIL: Soe\ I\c.I.cck 1D' -Nver • t"Required for Work in Public Right-of-Way CONTRACTOR NAME: 14Cl CI' (3ro rI've koyweI CONTRACTOR ADDRESS: STREET 3 c{2 2 '0-7 +j A-v( /V C.= CITY V \ S V 1 I ‘te STATE ZIP ! e 713 CONTRACTOR PHONE: Li 26 2 e0-2 4? q 1CONTRACTOREMAIL: J (Lc-tor o4 1vp rt, ( 0M CONTRACTOR LICENSE#(REQUIRED):14cxoc' (3 I 0 1 2 D Z EVERETT BUSINESS LICENSE#(REQUIRED):05 3 /b PRIMARY CONTACT: (OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: lk 2 S- 2 ef 0 -- 2 y 2 / �cye l (At a c� CONTACT EMAIL: 3 oe l \ ck ci t\e l c o 4-ti,ce rl. C t7*"-I 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 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 -20 - Z.a PW °—fin - 602-- Owne u orized Agent Signa �� Date (Revised 1/72019)