1915 GRAND AVE 2023-09-08 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION 0 CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 i FAX 425-257-8857 1 (E) everetteps@everettwa.gov i https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1915 Grand Ave, Everett WA 98201 SITE WORK FOR PROJECT TYPE: ❑✓ SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU []MULTI -FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT # UTILITY COMPANY'S NAME & JOB #: JOB # DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: ❑ FENCE IN ROW ❑ DRIVEWAY APRON / CURB CUT ❑ ASPHALT / CONCRETE PAVING ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT ❑ CLEARING / GRADING / FILL / EXCAVATE ❑ CUT/BORE IN PAVEMENT (PARALLEL) ❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) ❑ POLE WORK / AERIAL / OVERLASH ADDITIONAL DESCRIPTION (AS NEEDED): FT IN HEIGHT FT WIDE SF LF FT TOTAL HEIGHT CY LF LF LF DRAINAGE MITIGATION QUESTIONS: STORMWA TER DISCHARGES TO: ❑ Combined Sewer ❑ Separated Storm Sewer ❑ Direct Discharge to Snohomish River or Puget Sound TRIGGERED REQUIREMENTS: ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 QUANTITY OF PROPOSED HARD SURFACES: Proposed Roof Area: SF Proposed Hardscape: SF ITotal New + Replaced: SF Remove diseased cherry trees in right-of-wav (see attach.) and retrace with Chinensis Kousa Dogwood CONTACT INFORMATION OWNER / APPLICANT NAME: Sarah Heckman OWNER / APP. MAILING ADDRESS: sT1EET1915 Grand Ave CITY Everett STATE WA zip 98201 OWNER / APP. PHONE:808-651 -3260 OWNER / APP. EMAIL: sarah.heckman@icloud.com / sarah.heckman@snoco.org 'Required for Work in Public Right -of -Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: ✓❑ OWNER / APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) CONTACT NAME: Sarah Heckman CONTACT PHONE:80$-651-3260 / 425-388-7410 CONTACT EMAIL: sarah.heckman@icloud.com / sarah.heckman@snoco.org 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. 1 am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT # PW Owner/Authorized Agent Signature Date /, (Revised 1172019)