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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)425-25T-UlO 1 FAX 425-257-8857 1(E)everetteps@everemva.Gov I https:llevemtwa.gov/p rmits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 1431 Wetmore Avenue <br />SITE WORK FOR PROJECT TYPE: OSFR-DETACHED EITOWNHOUSE I]DUPLEX QADU CMULTI-FAMILY OGOMMERCIAL DINDUSTRIAL <br />IF APPLICABLE: G LAND USE PROJECT X (SEPA, PRE-APP, SS, ETC.) <br />IFAPPLICABLE: ❑FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT# <br />UTILITY COMPANY'S NAME B JOB III: JOB# <br />DESCRIPTION OF SITE WORK I RIGHT-OF-WAY WORK <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />G FENCE IN ROW 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 />0 RETAINING WALL I ROCKERY OVER AFT IN HEIGHT _FT TOTAL HEIGHT <br />® CLEARING I GRADING I FILL I EXCAVATE 10 Cy <br />13 CUTBORE IN PAVEMENT (PARALLEL) LF <br />O CUTBORE IN PAVEMENT(NON-PARALLEL) LP <br />O POLE WORK I AERIAL I OVERIASH LF <br />ADDITIONAL DESCRIPTION IAS NEEDED: <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />OCombined Sewer <br />OSmani Sturm Saner <br />GDirect Db INTS, to Srmlmrmirm River or Puget Sound <br />TRIGGERED REQUIREMENTS.' <br />13MR20nly 13MRI-5 OMR1-9 <br />QUANTITY OF PROPOSED HARD SURFACES: <br />Proposed Raul Ama: SF <br />Proposed Hartlecapa: SF <br />ITOMI New a Related: SF <br />CONTACT INFORMATION <br />OWNER I APPLICANT NAME: Steve Pound <br />OWNER IMP. MAILING ADDRESS 1i Wetmore Avenue <br />r Everett STATE WA ae 98201 <br />OWNER IMP. PHONE: 425-2805890 <br />OWNER I APP. EMAIL: okleinwa@hctmail.Com <br />'Required for Wont In Public Riehnof Way <br />CONTRACTOR NAME: Bluestone Environmental NW <br />COMRACTORADDRESS 11E, 27177185th Avenue BE, Suite 111.224 <br />,. Covington m WA 98042 <br />CONTRACTOR PHONE: 253'951-2024 <br />CONTRACTOR EMAIL: ddnM1@Nuesternenw?Wm <br />CONTRACTOR LICENSE#IREQUIRED): BLUESEL79100 <br />EVERETT BUSINESS LICENSE#(REQUIRED): Applied PH <br />PRIMARY CONTACT: ❑ OWNER I APPLICANT 000NTRACTOR ❑ OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: <br />Dan Hatch <br />CONTACT PHONE: 253-951-M24 <br />CONTACT EMAIL: tlenh@NuesWnenw.com <br />ACKNOWLEDGEMENT: I ham revlewatlths appreeim andamfind Me inbnaafloc condinedlreroo is true and comct WMd epumeanllothis�lmcs! <br />ccrnplywiii currentlAdd Me Butte antl KKallamney Gang su Olaperunderaauf! 'resapprola way rmer tlevamsur Wmeof by. pevidlons mustwAOB <br />aullwn'mdin x�iNrlg /rwn Me BuiWmp Olficial6e(red corrradM1cdmdSfam nyciraurrui wl8.am My md2orl am aullrcn'md 6y Me ownerol Mis pmpedyb <br />per/ Me wok hrrMkll epp'rcelien lc rrlm'e, entllcamp'Y with Me$lela Cmha`Ide law iB2]RCWend49a NpAWAC. <br />LkydEvmtt O/flNBI Use Q'ny <br />PERMIT# <br />Dan Hatch"'0^°""°'"""`'" PW <br />OwnsdAuthorlmd Agent SnrlaOrn Daft (Revised 1/ 19) <br />