3 W INTERCITY AVE 2023-09-07 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMnT INSTRUCTIONS: Email applkeRn 85ubmlMl documents FwmM1eervlwa($ee'rentM.wo or dop air at Stan ears Spain 2nd Fair Drop So WASHPINGTON CONTACT INFORMATION.(P)42525T 88101(E) PermllServlces@averefteak w llw) evmetlxagwlPormils PROJECT SITE INFORMATION PROJECT ADDRESS: 3 W intercityAve Everetl, WA 98200 SITE WORK FOR PROJECT TYPE: DSFR-DETACHED OTOWNHOUSE OOUPIrx DAOV DMUITI-FAMILY OCOMMERCIAL OINDUSTRIAL IF APPLICABLE: O t ND USE PROJECT N (SEPA, PRE-APP, SS. ETC.) IFAPPLIOABLE: E21FRANCHISENTILITY COMPANY, ANNUAL BLANKET PERMIT UTILITY COMPANY'S NAME B JOB Y: JOB C: DESCRIPTION OF SITE WORK I RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE ❑ FENCE IN ROW NIA FT IN HEIGHT ❑ DRIVEWAY APRON I CURB CUT NIA FT WIDE D ASPHALT I CONCRETE PAVING 664 SF ❑ RETAINING WALL I ROCKERY IN RIGHT-0E-WAY NIA LF ❑ RETAINING WALL I ROCKERY OVER JET IN HEIGHT WA FT TOTAL HEIGHT ❑ CLEARING) GRADING) FILL I EXCAVATE NIA CY ❑ CUTWRE IN PAVEMENT(PARALLEL) NIA LF O CUTWRE IN PAVEMENT( NON -PARALLEL) NIA LF ❑ POLE WORK I AERIAL I OVERLASH NIA LF ADDITIONAL DESCRPTON (A9 NEEDED): DRAINAGE MITIGATION QUESTIONS: STORMWATER DISCHARGES TO: DOombined Sever D Separated Storm Sever DDirect Discharge to SmMmism River or Puget Sound TRIGGEREDREQUIREMENTS: Dabbi DMRPS Doi QUANTITY OF PROPOSED HARD SURFACES: Proceed Roof Area: SF Promund Hardsoape: SF Total Nam a Replaced. SF Replace de property old concrete sidewalk, front old wood porch to concrete and laid down a new sidewalk on op i QT US Driveway. CONTACT INFORMATION OWNER I APPLICANT NAME: Cadge Lgmeli OWNER I APP. MAILING ADDRESS E' 3 W Intercity Ave Everett �TATE WA zip N204 OWNER I APP. PHONE: 425-2208188 OWNER I APP. EMAIL camachoC ulln@gmail.com 'Required for Work In Public Rightof Way CONTRACTOR NAME: NIA CONTRACTOR ADDRESS: SMEET CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE pREOUIRED): EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: p OWNER I APPLICANT ❑CONTRACTOR ❑ OTHER(Archipact, Engineer, Etc.) CONTACT NAME: Carlos Lomeli CONTACT PHONE: 42882051g GONTACT EMA L:m N=mu=emumm ACKNOWLEDGEMENT I have reviewed this Apormfion and wnlirm Me iMonrlation conhimd herein is Are aM wnxl. Work doaw pxsoanlro Mis par it must comply with cuneni hmA i. state, and mcal lawOn granting an parmii mi memories approved wank and ma d onward merehwn. DeviarMns mkit nrACar aNlMmd M RitMg fiver the Bulldmg OMcal RASA being aNlMmd tree ny cvrtumslanro. I am the owner, or l am awhorded by Me owner dthis property, to random fire work for Much application is more, and comply worm the State Contractors Law 1827 RCW and MUBMA WAC. Clry ofOnarad (aft Use Gary FERMI Carlos Lomeli 07/25/2023 IPW 19 OwnarlAulhorizad Agent Signature Dale (ReWedW21/2022)