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PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETTSUBMRT INSTRUCTPW Email xFnkeRn b Nancel EaumanbMOr drop off at 3200 Order eheN 2nd Floor Drop GO. <br />WASHINGTON CONTACT INFORMATION. Pit 425-257-8810i (E)POrmitServlcovrowerelwa.gwi(W)evmetlxa.pw/Pormils <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: Hannabrook Park (5815 Brookridge Blvd.) <br />31TE WORK FOR PROJECT TYPE: OSFR-DETACHED OTOWNHOUSE ODUPLEX OADU OMULTFFPMILY DCCMMEROIAL DINDUSTRIPL <br />IF APPLICABLE: ■ LAND USE PROJECT # (SERA, PREAPP, SS. ETC.) <br />IF APPLICABLE: I]FRANCHISEIUTILITY COMPANY, ANNUAL BLANKET PERMIT# <br />UTILITY COMPANYS NAME S JOB#: JOB#: <br />DESCRIPTION OF a <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />❑ FENCE IN ROW ET IN HEIGHT <br />❑ DRIVEWAY APRON I CURB CUT FTWIDE <br />O ASPHALT I CONCRETE PAVING SF <br />❑ RETAINING WALL I ROCKERY IN RIGHT-OF-WAY LF <br />❑ RETAINING WALL I ROCKERY OVER JET IN HEIGHT FT TOTAL HEIGHT <br />■ CLEARING) GRADING) FILLI EXCAVATE 60 ry exravete OY <br />O CUTWRE IN PAVEMENT(PARALLEL) LF <br />O CUTWRE IN PAVEMENT (NON -PARALLEL) LF <br />❑ POLE WORK I AERIAL I OVERLASH LF <br />ADDITIONAL DESCRIPTION AS NEEDED): <br />-WAY WORK <br />DRAINAGE MnIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />OOombined Saner <br />■ Seperaed Stan Serer <br />G Damn Discharge To Scouter River or "Pet Sound <br />TRIGGERED REQUIREMENTS: <br />Omn2only I]MRPS I]1,111 <br />QUANTITY OF PROPOSED HARD SURFACES: <br />Proposed Root Area: SF <br />Proposed HeNsrape: SF <br />Total Nary • Replaced SF <br />Excavation in five separate locations to accommodate installation of equipment stations <br />CONTACT INFORMATION <br />OWNER I APPLICANT NAME: Brad Chenomth <br />OWNER IAPP. MAILINGADDRESS maut,802 E Mukilteo Blvd <br />rn diEverett .TIE WA <br />IMP. PHONE :42530839390 <br />OWNER I APP. EMAIL bchenoweth@everettwa.gov <br />'Required for Work In Public RightPri <br />CONTRACTOR NAME: Northwest Playground Equipment <br />CONTRACTORADDRESS: Sri Northwest Dogwood <br />cm Issaquah <br />STATEWA n, 98027 <br />CONTRACTOR PHONE:4253139161 <br />CONTRACTOR EMAL:eric@nwplaygfound.COm <br />CONTRACTOR LICENSE INREQUIRED): NORTHPE044DJ <br />1EVEREPT BUSINESS UCENSE#(REQUIRED): 44484 <br />PRIMARY CONTACT: ❑ OWNER IAPPLICANT ❑ CONTRACTOR ❑ OTHER (AmhitecL Engineer, Etc.) <br />CONTACT NAME:Brad Chenoweth <br />PH <br />CONTACT 0NE08939 <br />.425enoweM®33 <br />CONTACT EMAIL: bcM1evereLLwagw <br />ACKNOWLEDGEMENT I here reviexatl MkappNra(imantlwnrmm Me iMormation mntiimO haem is hueaM wmLi. Wok Mrwpxsuanlro Mk PomAlmurt <br />con"i with currentrede 'ante, and uomlaw . The granlingwa parent only auMames approved work and rw dawawns theresum. Dawawna mualoralas <br />eNlMmtlln mi14g henNa pyroph nOMcbli and being eNlMmtl untlerany mon; Law 18. <br />I am the owner, a1 am arAM1orheo'by Me owrrerdlM1ispmpaty to <br />parbrm Ilre ucrk for Much app'rcafion is nestle, andl ccmTJY w+M Me State (onfradors taw 182]RCW and 268.100A WAC. <br />CF/ orEwreHOMceI Use pay <br />BIND CHENOWETH e°°„n, md`;,.��"`"' <br />PW <br />OwneNAudorNetl AgaM Slplerure Daie (RoWWM li 22) <br />