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PILIC WORKS PERMIT 411PLICATION CITY OF EVERETT PERMIT SER CES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: ` '� ��/� ��t/"t/ eir-��3 SITE WORK FOR PROJECT TYPE: iiii.SFR-DETACHED ❑TOWNHOUSE El DUPLEX DADU ❑MULTI-FAMILY ❑COMMERCIAL El INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑ FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: O DRIVEWAY APRON/CURB CUT _ FT WIDE 0 Combined Sewer ASPHALT/CONCRETE PAVING 6C-"lJ SF ❑ Separated Storm Sewer RETAINING WALL/ROCKERY IN RIGHT-OF-WAY 39 LF (ZI �.> ❑ Direct Discharge to Snohomish River or Puget Sound ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑ CLEARING/GRADING/FILL/EXCAVATE CY ❑ MR2 Only ❑MR1-5 ❑MR1-9 ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITrpF PROPOSED HARD SURFACES: ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF r l ❑ POLE WORK/AERIAL/OVERLASH LF Proposed rdscape: SF y . ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced:A 2 g ^nth; f • Permit CONTACT INFORMATION OWNER/APPLICANT NAME: '/gay / I a r/7cr" OWNER/APP. MAILING ADDRESS: STREET q/2., I/ete f_ CITY STATE 1 / 4 ZIP%��< / �j /OWNER/APP. PHONE: / .5' 7C�- 7!/S i OWNER/APP. EMAIL: f/uybe J- `7nzv/ 1,U/7I `Required for Work in Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQC11'RED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: OWNER /APPLICANT ❑ CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: ACKNOWLEDGEMENT I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must 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 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 perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# / PW \c 0(Q -- cc Owner/ uthorized Agent Signature Date (Revised 4/15/2019)