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PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETTSUBMITTAL iINSTRUCTIONS: EeAdwalullon 6eudeW daunnnle Mp.rmAS.nNe¢®.wMM'a.9w arrant Oat 320D Le4e, 5eeel Ad Floor Dan noa <br />CONTACT INFORMATION: (PI<R5-25T-08101(E) Permitservi marevereartedaov l IM evennovanowpermite <br />PROJECT SITE INFORMATION " <br />PROJECT ADDRESS:5134 W Highland Rd, Everett WA. 98203 <br />SITE WORK FOR PROJECT TYPE: IIIIIISFR-DETACHED OTOWNHOUSE ODUPLE%DADU OMULTFFAMILY OCOMMERCIAL DINDUSTRIAL <br />IP APPLICABLE: ❑ LAND USE PROJECT M (SERA, PRE-APP, SS, ETC.) <br />IF APPLICABLE: "IFRANCHISEUTILITY COMPANY, ANNUAL BLANKET PERMITN <br />UTILITY COMPANY'S NAME &JOB N: JOB N: <br />DESCRIPTION OF SITE WORK I <br />-WAYWI <br />DRAINAGE MITIGATION QUESTIONS: <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />❑FENCE IN ROW 6 FT IN HEIGHT <br />❑ DRIVEWAYAPRON I CURB CUT FTWIDE <br />❑ ASPHALT I CONCRETE PAVING SF <br />• RETAINING WALL I ROCKERY IN RIGHT-OF-INAY _LF <br />❑ RETAINING WALL I ROCKERY OVER AFT IN HEIGHT FT TOTAL HEIGHT <br />❑ CLEARING I GRADING I FILL I EXCAVATE CY <br />O OUTIBORE IN PAVEMENT (PARALLEL) LF <br />❑ CVTIBORE IN PAVEMENT(NON-PAMMEL) LF <br />❑ POLE WORK I AERIAL I OVERLASH LF <br />ADDITIONAL DESCRIPTION AS NEEDED): <br />STORMWATER DISCHARGES TO: <br />Ocmnained Sewer <br />O Separated 5lorm Serer <br />O Olrocl Discharge to SnolloMch Rhrer ar Puget Settled <br />TRIGGERED REQUIREMENTS: <br />13MR20Ny ❑MRId Mmmn; <br />QUANTITY OF PROPOSED HARD SURFACES: <br />Proposed Raol Anot BE <br />Proposed Hmdsape: SF <br />Total New +Re aced SF <br />CONTACT INFORMATION <br />OWNER I APPLICANT NAME:Charles and Kathleen Hickman <br />OWNER ARE. MAILING ADDRESS: ITREaT5134 W Highland Rd <br />mr Everett sTATEWA :IR98203 <br />OWNER I APP. PHONE: <br />JOWNER I APP. EMAIL: <br />'Requlretl for Wmkln Publl< Right -of -Way <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: 61 <br />Color STATF ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE CREOUIRED): <br />IEVERETT BUSINESS LICENSE N(REGUIREO): <br />PRIMARYCONTACT: ■OWNER /APPLICANT ❑CONTRACTOR ❑ OTHER (Architect Engineer, Etc.) <br />CONTACT NAME: Kathleen Hickman <br />CONTACT PHONE:42523' 0532 <br />CONTACT EMAIL:khlckman <br />firstam.com <br />Is merle, and I comply won the Stale fnnlreciore Lew 1827 RCW find 2911T)(24 WAC. <br />FIKWI IF <br />CXy MErereN OIfiNN Uw OnIY <br />zz 1PW 2201 -OIL <br />�' .�' rRewaeda212pzy <br />