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SEEM PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETTSNamRTALWeTRUCTIPNNWASHINGTON Rm.papp�INaweMwlaowm.m,N IM.w M w<wp . We 5.r,,FNorNwe <br />CONTACT INFORMATION: IPI415Zii1 NE) PermHServicec®eaereltue.saw l(W) anerecamIlA /permld <br />PROJECT SITE INFORMATION <br />PROJECT ADDREBa:3]25 Federal Ave; Everett, WA 98201 <br />SITE WORK FOR PROJECT TYPE: GSFR-0ETACHEO OTQWNHOUSE ODOPIE% OAOD OMDLTI-FAMILY ECObaiffl L 0INDUSTRIAL <br />WAPPLICABLE:❑WJDUSEPRWECT#(SEPAPRE-PPP,SS,ETC.) <br />IF APPLICABLE: []FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT <br />UTILITY COMPANY'S NAME& JOB#: JOB#: <br />DESCRIPTION OF SITE WORK / RIONT-OF-WAY WORK <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />III FENCE IN ROW 3.5 FT IN HEIGHT <br />❑DRIVEWAY APRON/CURB CUT FTWIDE <br />❑ ASPHALT I CONCRETE PAVING SF <br />❑ RETAINING WALL I ROCKERY IN RIGHT-0E-WAY IF <br />❑ RETAINING WALL I ROCKERY OVER 4FT IN HEIGHT FTTOTALHEIGHT <br />❑ CLEARING I GRADING I FILL/EXCAVATE CY <br />❑CUT/BORE IN PAVEMENT (PARALLEL) IF <br />❑CUT/BORE IN PAVEMENT(NON-PARALLEL) IF <br />❑ POLE WORK I AERIAL /OVERIASH LF <br />ADDITIONAL DESCRIPTION AS NEEDED: <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />❑camared Scher <br />OSeperema Sam Seer <br />Olind Dls e0 Sindm sb RNCr Or Pupal Sand <br />TRIGGEREDREQUIREMENTS: <br />OMR2anly l3rai OMRtB <br />QUANTITY OF PROPOSED HARD SURFACES: <br />PTaweetl RodPree: SF <br />Pmpwed HerrMeeepe: SF <br />Toch New, handmaj SF <br />3.511 high vinyl picket fence along, Federal Ave including a gate at the midway <br />point. This <br />replaces the existing <br />fence in the same location. Also, 3.5 8 high chain link fence from the norlhend <br />IF <br />of <br />the vinyl <br />of replacement fence <br />down a Ang t he in Wei Inc; udiny be gatu at III qua, IS, pul R. I a POP sued t IV ex St I pq he Had I I I Is Si Just 011. <br />CONTACT INFORMATION <br />OWNER I APPLICANT IMME:Stblphen Bralthau t <br />OWNER APP. MAILING ADDRESS: Grabli Federal Ave <br />cm Everett STATE WA ,,,98201 <br />OWNER/ APP. PHONE425-299-2443 <br />OWNER/ APP. EMAILSabjwb001Cngmall.COm <br />'RegNrctl Far Work In Public RigMat-Way <br />CONTRACTOR NAME: Campbell Fence Company LI_C <br />CONTRACTORADDRESS: Suni loth St <br />W Snohomish STATe WA m,98290 <br />CONTRACTOR PHONE:�425�-381-387g <br />CONTRACTOREMAILCampbellfencingm@gmall.COm <br />CONTRACTOR LICENSE#(REQUIRED:CAMPBFC802PN <br />EVERETT BUSINESS LICENSE INREQUIRED). jL4 <br />PRIMARY CONTACT: II OWNER/APPLIC{A�NT ❑CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME:StP.I�hen Bl-P.IYIIaUII��t <br />Y Y <br />CONTACT PH0 E.425-299-2443 <br />CONTACT EMAILsabjwM01®Bmall.mm <br />ACKNOWLEDGEMENT I nave leWawxa this gcplkeWn Salami She lnlamMA cuM w Mnar a Trim and cos t Wwk Eoro puwaM An lMmared ma# <br />comply Ave w^anrfeawiall andki law. The pnnlirg d a pa t me awbwires appmvsa rwk aM an dsvial aces m ..Dewar muM rnrt be <br />ewMimh MAIWTmmme HC Is MIebe beings, eah an SMaenyalralm Lallc1827 Ma Wmar,wlamewTra¢ea nymaalwlazMllNsp'opwlya <br />pMwm mawaxra wblrn aPANceLbn /a pace, anal paawN nan me S(ele CoMreclon Law tBZFRcwamzsezlma was <br />Vi,�nJMe7 I/ti%023 PWti3�I" 0OS <br />OVAI#hofiud Agent SlgneWre De (4rz1/L#21) <br />