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mom P ` LIC WORKS PERMIT Adel' LICATI�•
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<br /> CITY OF EVERETT PERMIT SERIIFES
<br /> E VERETT 3200 CEDAR STREET, EVERETT, WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov) https://everettwa.gov/permits
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<br /> PROJECT ADDRESS: 2 7 A T!7iAi',."-,y F ,
<br /> SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU,"lV1ULTI-FAIV LY ❑C•O`11MERQIALFCIJNDUS„TRIAL
<br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) I r''
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<br /> FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS:
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<br /> FENCE IN ROWS74 FT IN HEIGHT STORMWATER DISCHARGES TO:
<br /> ❑DRIVEWAY APRON/CURB CUT , , ,,r 24: FT WIDE grCombined Sewer
<br /> ❑ASPHALT/CONCRETE PAVING /t/ Y� SF 1(Separated Storm Sewer
<br /> El RETAINING WALL/ROCKERY IN RIGHT-OF-WAY /V/ LF 0 Direct Discharge to Snohomish River or Puget Sound
<br /> 0 RETAINING WALL/ROCKERY OVER 4F I N H IIGGHT Q FT TOTAL HEIGHT TRIGGERED REQUIREMENTS:
<br /> 0 f'a/ _'^�,..c'i'7�, 4• Rr "k v e Aa 6e.•. ;•
<br /> El CLEARING/GRADING/FILL/EXCAVATE IC, (20 CY 0 MR2 Only 0 MR1-5 0 MR1-9
<br /> CUT/BORE IN PAVEMENT(PARALLEL) Co Y"A-4 L ti7-, LF A Z2.15t) QUANTITY OF PROPOSED HARD SURFACES:
<br /> CW 1 4
<br /> 121 CUT/BORE IN PAVEMENT(NON-PARALLEL) /3 LF Proposed Roof Area: S 1 00 0 SF
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<br /> ❑POLE WORK/AERIAL/OVERLASH /( LF Proposed Hardscape: SF 3 L A-e,,zrPfl5
<br /> ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced:SA Inn L=— SF L.4-r---.
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<br /> OWNER/APPLICANT NAME: s)<o -t-`j AL_ 5,O L>„t—C
<br /> OWNER/APP. MAILING ADDRESS: STREET PO /3o) Z.772 7
<br /> CITY Ate'-/ ` ;,/ STATE `- ZIP 9 .---
<br /> OWNER/APP.PHONE:- ' L 2✓G 5-yVd OWNER 1 APP.EMAIL: A-/ T 0 ..5k 11 44 ' ,
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<br /> *Required for Work in Public Right-of-Way
<br /> CONTRACTOR NAME: l t/ 5 n , i'' (-T-,Q i,,J%`fo' RA-AA . d .4
<br /> CONTRACTOR ADDRESS: STREET f t,
<br /> CITY A-1 1--i UJ� IT0IAJ STATE Z/--1/4-- ZIP"7 .7 J
<br /> CONTRACTOR PHONE: 4-I�,5"-4-(a7 I & 5? CONTRACTOR EMAIL: K -Nivr (,(/ / 7 t:-,..krgr G P 4 tL ii
<br /> CONTRACTOR LICENSE#(REQUIRED): 6 D,4 -(3 8i --q a c) EVERETT BUSINESS LICENSE CREQUIRED): 6 0 73 M
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<br /> PRIMARY CONTACT: ,'OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect, Engineer, Etc.)
<br /> CONTACT NAME: CONTACT PHONE: ^'" - - / o
<br /> RI- , k0 i.9A-4_—. CONTACT EMAIL: ,4-)2.T a `►•.7.-VA ' °`' sr.
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<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 any circumstance.I 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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> gjef..adeViSelS?-1,:?-;611
<br /> � 'r,I PERMIT#
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<br /> A, PW i q --
<br /> OwnerlAuthorized Agent Signature Date (Revised 4/15/2019)
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