4201 RUCKER AVE COMMUNITY HEALTH CENTER 2023-09-11

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-25T-UlO 1 FAX 425-257-8857 1(E)everetteps@everemva.Gov I https:llevemtwa.gov/p rmits PROJECT SITE INFORMATION PROJEOTADORE55:4201 Rucker Ave. SITE WORK FOR PROJECT TYPE: OSFR-DETACHED OTOWNHOUSE ODUPLEX QADU ONAULTI-FAMILY ®COMMERCIAL DINDUSTRIAL IF APPLICABLE: G LAND USE PROJECT 9 (SERA, PRE-APP, SS, ETC.) IF APPLICABLE: 13 FRANCHISEIUTILITY COMPANY, ANNUAL BLANKET PERMIT K UTILITY COMPANY'S NAME B JOB N: JOBN DESCRIPTION OF SITE WORK I RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: O FENCE IN ROW FT IN HEIGHT O DRIVEWAY APRON I CURB CUT 20 FTWIDE 9 ASPHALT I CONCRETE PAVING 123 SF O RETAINING WALL I ROCKERY IN RIGHT-OF-WAY LF ® RETAINING WALL I ROCKERY OVER ART IN HEIGHT 132 FT TOTAL HEIGHT ❑ CLEARING I GRADING I FILL I EXCAVATE CY O CUTSORE IN PAVEMENT( PARALLEL) LF O CUTIISORE IN PAVEMENT(NON-PARALLEL) LF O POLE WORK I AERIAL I OVERLASH LF AOmTIONAL OESCWPTIONAS NEEDED: DRAINAGE MITIGATION QUESTIONS: STORMWATER DISCHARGES TO: OCombined Sever EJ smarated storm Saner G Direct DbMargs to Snomminb River or Puget Sound TRIGGERED REQUIREMENTS.' OMR20nly 13MRI-5 OMR1-9 QUANTITY OF PROPOSED HARD SURFACES: Proposed Root Area: SF Proposed Hamscam, 123 SF Total New+ Relaced'. 26'%9 SF The protect consists of site work modifications to an access driveway, replacement of an existing parking lot retaining wall, and refurbishing of landscape irrigation and vegetation. CONTACT INFORMATION OWNER I APPLICANT NAME. Community Health Center of Snohomish County OWNER IMP. MAILING ADDRESS STREET 8609 Evergreen Way r Everett STATE WA at 98208 OWNER IMP. PHONE: 4257893800 OWNER IAPP. EMAIL: dkaWntenov@chcsno.org 'Required for Work In PuNka Rini Way CONTRACTORNAME: Aldrich+A6socalel Inc. CONTRALTORADDRESS EEr81O 240 SL BE .y Bothell sTAr, WA ZIP CONTRACTOR PHONE: 425483-1313 CONTRACTOR EMAIL: gwarG@aldrichasso0.Wm CONTRACTOR LICENSE NIREQUIRED): CCALDRIA-202RU EVERETT BUSINESS LICENSE IIMEpuIREU): Mike PRIMARY CONTACT: ❑ OWNER I APPLICANT I]CONTRACTOR El OTHER (Archltect, Engineer, Etc.) ka`" CONTACT NAME: Janet Montle, ArchitecNrel Warhs, Inc. CONTACT PHONE: 425-823-22440r 425241-0081 CONTACT EMNLjenet@BwerkS.mm ACKNOWLEDGEMENT I ham forever this appeiver and real fin inbnnation contained lrenN is true and mrecY WM Eonepursuanlro Idis�rrrul must romply, work chat ledenl,stele, and met law. The grantin901a pelmtt oMy immediate sppmved wok and no devNfions lhemh peviafbre mast bw be monen'md in writry frwn Me BuiWrit;Co ial bakere becor sufromed underany ciraumakal l am the owner, or I am aullwn'md by Me owner of of properly So pert the work for "Go Sternal Is drome, entl l comply NSA the Sol fdRra`Ide few, 18.27 RCW end 29620bt WAG. Cry ofEvertt Oil Use Wry PERMIT# Janet Montle.,M^�—^---^—�— 191I22 PW OwnerlAUMorInd Agent 819natun Date (Revised EAGNI9)