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SEE PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETTSUBMRT INSTRUCTION Email appllcai B SwMMSIl Ecinne Mat So CwwMW2nd Fko,prmsex <br />WASHINGTON CONTACT INFORMATION. (P)42125T-881011E) Pe,mkSowicos®evem .gw I(W)evemtlxagw/pmmile <br />PROJECT SITE INFORMATION <br />PROJEOTADOREBB: Northeide Former Dry Cleaner Claremont Village Shopping Center 4821 Evergreen Way Everett Washington <br />SITE WORK FOR PROJECT TYPE: OSFR-DETACHED OTOWNHOUSE COUPLEX OAOU 0MULTI -FAMILY ®COMMERCIAL OINOUSTRIAL <br />IF APPLICABLE: O LAND USE PROJECT N (SEPA, PRE-APP, SS. ETC.) <br />IFAPPLIOABLE: QFRANCHISENT1UTY COMPANY, ANNUAL BLANKET PERMIT <br />UTILITY COMPANY'S NAME B JOB tl: JOB Y: <br />OEBCRIPTION OF 81 <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />❑ FENCE IN ROW FT IN HEIGHT <br />❑ DRIVEWAY APRON I CURB CUT FTWIDE <br />O ASPHALT I CONCRETE PAVING SF <br />❑ RETAINING WALL I ROCKERY IN RIGHT-DF-WAY LF <br />❑ RETAINING WALL I ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br />❑ CLEARING) GRADING) FILL I EXCAVATE OY <br />O CUTWRE IN PAVEMENT (PARALLEL) LF <br />O CUT)BORE IN PAVEMENT( NON-PARMLEL) LF <br />❑ POLE WORK I AERIAL I OVERLASH LF <br />DITIONAL DESCRIPTION AS NEEDED : <br />F-WAY WORK <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />ODombllel Swmrer <br />O Beperwed Slam Scow <br />O Dimct Discharge to Suabmisb River car Puget Sound <br />TRIGGEREDREQUIREMENTS: <br />OMR2only E3MR1-5 Del <br />QUANTITY OF PROPOSED HARD SURFACES: <br />Proposed Real Ares: SF <br />Pmpssed Hardecape: BE <br />local New a Replaced: BE <br />Inslallagon of "Free (3) temporary enWmnmenlal soil borings within the landscaping between the mM end of Claremont Village Shopping Gaoler and <br />Wilmington Ave. Soil borings will be backfilletl after completion. Estimated project time is one day. See figure aflacM1etl for boring IocatlOn6. <br />Private and public unity locales will be completed prior to wort No roadleldewalk closures or detours are anticipated_ <br />INFORMATION <br />OWNER I APPLICANT NAME: M%e Companies LLC Mr. Anders Uller <br />OWNER IAPP. MAILING ADDRESS: <br />ram aware STATE WA as Was <br />OWNERIAPP.PHONE: 425-757-1452 <br />OWNER I APP. EMAIL: anders.utler@apexcos com <br />'Requhed forelock In Public RgMM-Way, <br />CONTRACTOR NAME: Cas de Drilling. LP <br />CONTRACTORADDREW: sureser <br />ary . <br />CONTRACTOR PHONE: 425460-0588 <br />CONTRACTOR EMAIL: kgoblerecascade.env core <br />CONTRACTOR LICENSE NIREOUIRED): 692g4as5609IDWt <br />EVERETT BUSINESS LICENSE AREQUIREll 47889 <br />PRIMARY CONTACT: IN OWNER I APPLICANT ❑CONTRACTOR ❑ OTHER(Arohitect, Engineer, Etc.) <br />CONTACT NAME: Anders Utter <br />CONTACT PHONE: 425757-1452 <br />CONTACT EMAIL: anders.ul apexnds.ndm <br />ACKNOWLEDGEMENT IMree, andhetbisap The <br />graanewn(mm Meiayausiomm�himeed wais hod edwmsi. th Mr, pxsosnlrousties Pe ut <br />mnpy, corn curmnikee4, stele, eneunmlew. meprenrmBalapemrll enN audweaes ePPror-ee nwxawrw eewernns ene,e� .newewne mwrwnee <br />Model me <br />fo whWh a BUPUion is c ,"and beimgePath Me meeranycirthmslen IS. <br />am(3 owner,alrim wAIC. 'by Me owrrerdlM1ispmpety to <br />parbrm Ilre ucmk /orrsNcb epcHcefion is made, and I comply xiM Me State Confinecrom'taw 1&2]RCW eM 26a.100A WAG. <br />llv Gry of Everett OMneI Use QMy <br />12I1a2o22 PW <br />O OHAuthorized Agent SlpMre DNd (ReWWM lW 22) <br />