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PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P)425-25]-UlO 1 FAX 425-257-8857 1(E)everettegs@everettiva.Gov l https:llevemtwa.gov/p rmits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 1343 Madrona Ave <br />SITE WORK FOR PROJECT TYPE: OSFR-DETACHED OTOWNHOUSE ❑DUPLEX I]ADU ZIMULTI-FAMILY OGOMMERCIAL E31NDUSTRIAL <br />IF APPLICABLE: G LAND USE PROJECT 9 (SERA, PRE-APP, SS, ETC.) <br />IF APPLICABLE: O FRANCHISEIUTILITY COMPANY, ANNUAL BLANKET PERMIT # <br />UTILITY COMPANY'S NAME B JOB#: JOB# <br />DESCRIPTION OF SITE WORK I RIGHT-OF-WAY WORK <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />O FENCE IN ROW Up to 7ft high fence FT IN HEIGHT <br />O DRIVEWAY APRON I CURB CUT FTWIDE <br />❑ ASPHALT I CONCRETE PAVING SF <br />O RETAINING WALL I ROCKERY IN RIGHT-OF-WAY LF <br />O RETAINING WALL I ROCKERY OVER OFT IN HEIGHT _FT TOTAL HEIGHT <br />❑ CLEARING I GRADING I FILL I EXCAVATE Cy <br />O CUTSORE IN PAVEMENT (PARALLEL) LF <br />O CUTISORE IN PAVEMENT(NON-PARALLEL) LF <br />O POLE WORK I AERIAL I OVERLASH LF <br />ADDITIONAL DESCRIPTON AS NEEDED): <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />OCGmhllree Sews <br />O Soparaial Banner Smer <br />G Direct DbMarye to SroMmisb River or Puget Sound <br />TRIGGERED REQUIREMENTS.' <br />13MR20oly 13MRI-5 OMR+-9 <br />QUANTITY OF PROPOSED HARD SURFACES: <br />Proposed EGGS Arm SF <br />Proposed Hardecapi: SF <br />ITOMI New a Re laced: SF <br />CONTACT INFORMATION <br />OWNER I APPLICANT NAME: Greg and Amy Jo Stark <br />OWNER IMP. MAILING ADDRESS: iii Madrona Ave <br />rr Everett sTAmTNA Top 98203 <br />OWNER IMP. PHONE: 612-532-4426 <br />OWNER IMP. EMAIL: Btark.greg@gmall.com <br />'Required Yr Work In Puellc Rightaf Way <br />CONTRACTOR NAME: Beale$ Landscape Corp <br />OMTRACTORAIDDRESS STEET12105223RD AVEE <br />cry Bonney Lake sTAm WA e, 98391 <br />CONTRACTOR PHONE: 206-371-9792 <br />CONTRACTOR EMAIL realesiandscapecorp@hotmail.com <br />CONTRACTOR LICENSE#IREGUIRED): realelc937kq <br />EVERETT BUSINESS LICENSE AREpUIRED): <br />PRIMARY CONTACT: O OWNER I APPLICANT ❑CONTRACTOR ❑ OTHER (Archl+ect, Engineer, Etc.) <br />CONTACT NAME: <br />Greg Stark <br />CONTACT PHONE: 612-532-4425 <br />CONTACT EMAIL: Stark. r @gmail.com <br />ACKNOWLEDGEMENT: I ham mme this applrcalim anal confirm Meinbmralion contained herein is Tom and cwmcY WGM donepursuanlro ihia�mu(must <br />swMNwilll amerylforke Me Be antl KK Wbe Tve Bneg summeof unoMyauf! 'resapprwetl wok owner <br />tleWfionsano by.pemenvorof msfirsfhe <br />aullwn'mdin wniNng/rwn Me BuiWmp Olficial6e(ae bairq aulhanimd untleranycircumsRnro.lam the'and cry am aullrcn'md 6y Me uwnerol Mis pmperlyb <br />per/ Me wok hrwhich epp'rcelien le rrlm'e, entllcamply uvlh ale$letef.'ddra`Ide few iB2]RCWend49a WAG <br />prydEvmttOIflNBI Use Q'ny <br />PERMIT# <br />Gregory Stark � oN m"38 my 4narzD2+ PW <br />OwnerlAuMorlmd Agent Slpnatun Date (Reriaed f/120iB) <br />