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f'1LIC WORKS PERMIT PVLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> v <br /> EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I https://everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: �� /7 -���'1/:�, _,� !.'1 r!. i 1 !, <br /> SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX DADU ❑MULTI-FAMILY ❑COMMERCIALINDUSTRIAL <br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> DESCRIPTION OF SITE WORK I RIGHT-OF-WAY WORK <br /> FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: <br /> D,FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: <br /> ❑ DRIVEWAY APRON/CURB CUT .N/A FT WIDE KiCombined Sewer <br /> ❑ASPHALT/CONCRETE PAVING N/A- SF OSeparated Storm Sewer <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY N//-' LF ❑ Direct Discharge to Snohomish River or Puget Sound <br /> U1 RETAINING WALL/ROCKERY OVER 4FT II,HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: <br /> . - / -ram 4; l7.L) <br /> El CLEARING/GRADING/FILL/EXCAVATE /O/ Oc CY ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 <br /> CUT/BORE IN PAVEMENT(PARALLEL) Cr:v 1 A LF QUANTITY OF PROPOSED HARD SURFACES: <br /> ❑CUT/BORE INPAVEMENT(NON-PARALLEL) /`) LF Proposed Roof Area: 1 00 SF <br /> L.A, L •+ ,or1Ly <br /> ❑ POLE WORK/AERIAL/OVERLASH /S/ LF Proposed Hardscape: SFL Are,r1 r <br /> ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: M SF L.® <br /> / ;-- S�`�C v - <br /> — A/ C2,4. 2-/1} (.vim 772)0k s 7`,�,� <br /> CONTACT INFORMATION <br /> OWNER/APPLICANT NAME: S <<o --t---p t <br /> OWNER/APP. MAILING ADDRESS: STREET PO /30 X !, 2(o7 CITY F�--� •Vr ✓ STATE ) ZIP / OG '-' <br /> OWNER/APP. PHONE: '2 U/19.4 OWNER/APP. EMAIL: A T- 4:1J ���>rr' A f7 <br /> *Required for Work in Public Right-of-Way <br /> CONTRACTOR NAME: �(J �� ;7 �.:7' �T c E U- 0 R. i< ©(24 /) _) <br /> CONTRACTOR ADDRESS: STREET [6 .2 i I /- vr` N <br /> CITY /4 Q �v rd rui STATE I ZIP qg <br /> CONTRACTOR PHONE: =11 - i l CONTRACTOR EMAIL: \C,4 N D 1- (,f/e G PI4d L e Gem; <br /> CONTRACTOR LICENSE#(REQUIRED): c —D 8.Q 3 EVERETT BUSINESS LICENSE#(REQUIRED): 6 0 7.3 / <br /> PRIMARY CONTACT: ❑OWNER /APPLICANT ❑CONTRACTOR ❑ OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE:G/ 675 - 4I.,a) <br /> / I-- S KD 1 L2 4-4._ .-� .. ,. <br /> CONTACT EMAIL: /4-42.'r �� ,�1�!'' . 1'�� <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 /> PERMIT# <br /> gA/f : �• '1 :43riellij- PW <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) <br />