2717 FEDERAL AVE EXXON MOBIL 2023-09-12

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 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: 2717/2731 Federal Avenue Everett, Washington SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY 000MMERCIAL ❑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 # DESCRIMON OF SITE WORK / RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: STORMWATER DISCHARGES TO: ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON / CURB CUT FT WIDE ❑ Combined Sewer ❑ ASPHALT / CONCRETE PAVING SF ❑ Separated Storm Sewer ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF ❑ Direct Discharge to Snohomish River or Puget Sound TRIGGERED REQUIREMENTS: ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑ CLEARING / GRADING / FILL / EXCAVATE CY ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 QUANTITY OF PROPOSED HARD SURFACES: ✓❑ CUT/BORE IN PAVEMENT (PARALLEL) 23 LF ❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF Proposed Roof Area: SF ❑ POLE WORK / AERIAL / OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION (AS NEEDED): ITotal New + Replaced: SF Drill 23 borinas in the Citv of Everett right-of-wav using a direct push drill rig for the collection of soil samples. The borinas will be immediately backfilled and finished to match the existing grade with either dved concrete or asphalt. CONTACT INFORMATION OWNER / APPLICANT NAME: Robert Thompson OWNER / APP. MAILING ADDRESS: STREET 309 South Cloverdale Street CITY Seattle STATE WA zip 98108 OWNER / APP. PHONE: +1 206 510 5855 OWNER / APP. EMAIL: robert.thompson@)cardno.com *Required for Work in Public Right -of -Way CONTRACTOR NAME: Holocene Drilling CONTRACTOR ADDRESS: STREET 11412 62nd Avenue East �/�%Q CITY Puyallup STATE • � � ` ZIP 98373 CONTRACTOR PHONE: +1 253-848-6500 CONTRACTOR EMAIL: 1pender@holocenedrillinginc.com CONTRACTOR LICENSE #(REQUIRED): HOLOCD1044KH EVERETT BUSINESS LICENSE #(REQUIRED)_ 53216 PRIMARY CONTACT: [:]OWNER / APPLICANT ❑ CONTRACTOR ❑✓ OTHER (Architect, Engineer, Etc.) ENV Consultant CONTACT NAME: Robert Thompson CONTACT PHONE: +1 206 510 5855 CONTACT EMAIL: robert.thompson@cardno.com ACKNOWLEDGEMENT: l 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 1 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 # Robert Thompson Digitally signed by Robert Thompson o 00' Date: 2021.07.2711:23:56 06'00' August 10 2021 , IPW Owner/Authorized Agent Signature Date (Revised 1172019) n�t)