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PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETTSUeMRTALIxaTnai as &,submilahawmentsb IT at32m cad,,m,,I 2,1 Fao, Drop ads <br />WASHINGTON CONTACT INFORMATON: (P)425257-8111g I (E) PermgSeMcas®everea a.gw I ON) avaretlwe.goulpermlb <br />PROJECT SITE INFORMATION <br />PROJECT AQDNEmH930 Colby Ave, Evereff WA M201 <br />SITE WORK FOR PROJECT TYPE: 13SFRAETACHED OTOWNHOUSE ODUPLEX DADU OMULU-FAMILY DCOMMERCIAL OINOLIBRIAL <br />IF APPLICABLE: ❑ LAND USE PROJECT#(BEPA, PRE-APP, HE ETC ) <br />IFAPPLICABLE: []FRANCHISEIUTILITY COMPANY, ANNUAL BLANKET PERMIT# <br />UTILITY COMPANY'S NAME & JOB #: JDo <br />DESCRIPTION OF SITE WORK I RIGHT-OF-WAY WORK <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />❑FENCE IN ROW FT IN HEIGHT <br />❑DRNEWAY APRON/CURB CUT FT WIDE <br />IS ASPHALT I CONCRETE PAVING Boo SF <br />❑ RETAINING WALL I ROCKERY IN RIGHT-OF-WAY LF <br />❑RETAINING WALL ROCKERY OVER AFT IN HEIGHT FTTOTALHEIGHT <br />❑ CLEARING /GRADING/FILL I EXCAVATE BY <br />❑ CUTIBORE IN PAVEMENT(PARALLEL) LF <br />❑ CUPBORE IN PAVEMENT (NON -PARALLEL) LF <br />❑ POLE WORK I AERIAL/OVERLASH LF <br />ADDITIONAL DESCRIPTION RUS NEEDED: <br />DRAINAGE Mon"TICH QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />IS camuned Sewer <br />O Separated Smnn Samar <br />O Died OMORIS to ScOnamiab Rlveror Puget Sound <br />TRIGGERED REQUIREMENTS: <br />o0 net new area <br />OMB2OnW OMR1S OMRta <br />QUANTRYOFPROPOSEOIWRDSURFACES: <br />Proposed RcafAlBa: SF <br />Propmee Hanimeme: 800 OF <br />Teal New+Rmlamd800 w <br />replace existing Concrete driveway - no net new hard Surface, only replacement <br />CONTACT INFORMATION <br />OWNER I APPLICANT NAME:PahiCk & Cheryl Cline <br />OWNER/APP. MAILINGADORESS: nareT930 Colby Ave <br />„Y Everett STA,E WA 71,98201 <br />OWNER/APP. PHONE: <br />OWNER I APP. EMAIL: <br />'Required fm Wmk In POW fthtI -Way <br />CONTRACTOR NAME: AA Plumbing <br />CONTRACTOR ADDRESS: SMEET3527 238th St NE <br />nr Arlington Santa WA aE 98223 <br />cowrRACTOR vaoNE:425-923-9927 <br />CONTRAcroR EMAIL:aaplumbingllc247@gmail.com <br />CONTRACTOR LICENSE#(REQUIREEkAAPLU L`011 PD <br />EVERETT BUSINESS LICENSE#(REOUIREDk 05155E <br />PRIMARY CONTACT: /APPLICA4NL.T 9CONTRACTOR ❑OTHER (MCM1l1 tEg Engineer, Etc) <br />CONTACT NAME: r❑{OWNER <br />MCIICa III <br />CONTACT <br />CONTACT PHOn5-923-9927 <br />CONTACT EMAIL:aaplamanggc24TQgmail com <br />ACKNOWLEDGEMENT Imo andconed. Wmkdonepxnlronl of mParmlf mutt <br />mlyly wlfF cweN ledeM, alai& antl bcal Isw. Tha Onnfirg a(a Permg oMy eullwdzsa approved woM and no tlevlelbrm Ilwnlrom. IX vlelbns must lrel be <br />amryMzadln Safdgrmm IM BWMIn00RrclelDetare 5alrgaWAmname atlar any NmumsYance. lam the owner, or l am sulbanzstlbylM owneralllileprapeXyb <br />pe(oam the xaMhr Wrkb appV[elbnbmede, and l xmptyuirb the Slate CbNrecbrs Law i&2IR0W and 286200A BAG. <br />C16' offameft GREAT Up OM' <br />OwnedAumorlaed Agent Signature Dare (Remsed4CIAN 7 <br />