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PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETTSUBMnT INSTRUCTPW Email appkeRn b submand roamedMPsmM1Bervlwa($ee'renRvagpv Or ErtP M at 3An Olds eheN 2nd Road Dap GO. <br />WASHINGTON CONTACT INFORMATION. R)425-25]-8810i (E) POrmBServlcec@avemmai .gwi(W)evmetlxa.pw/Pormila <br />PROJECT 817E INFORMATION <br />PRWECTADUREBB: 11405 Silver Lake Road, Everett, WA 98208 <br />31TE WORK FOR PROJECT TYPE: OSFR-DETACHED OTOWNHOUSE ODUPLEX OADU OMULT-FAMILY OCCMMERCIAL 01NDUSTRIPL <br />IF APPLICABLE: ■ )AND USE PROJECT g (SERA, PREAPP, BE, ETC.) no SEPA requirement <br />IFAPPLICABLE: ❑FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMITS <br />UTILITY COMPANWS NAME S JOB C: JOB k: <br />DESCRIPTION OF a <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 RIGHTPOF-WAY LF <br />❑ RETAINING WALL I ROCKERY OVER JET IN HEIGHT FT TOTAL HEIGHT <br />❑ CLEARING) GRADING) FILL I EXCAVATE OY <br />O CUTWRE IN PAVEMENT(PARALLEL) LF <br />O CUTBORE IN PAVEMENT(NON-PARAU-EL) LF <br />❑ POLE WORK I AERIAL I OVERLASH LF <br />ADDITIONAL DESCRIPTION IAS NEEDED): <br />-WAT WORK <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />OOombined Satyr <br />O Seperaund Storm Saw <br />G Dead Discharge to Sminmiab River or Roger Sound <br />TRIGGEREDREQUIREMENTS: <br />OMe2only QMRPS [31,111 <br />QUANTITY OF PROPOSED HARD SURFACES: <br />Proposed RODTM:0 SF <br />Propssed Herdsaape: 0 SF <br />Toal New a Repleced0 BE <br />See Small Work Stormwater Site Plan/Report prepared by PERTEET 4/13/2022 <br />CONTACT INFORMATION <br />OWNER [APPLICANT NAME:Bra l ChernoWBth <br />OWNER IAPP. MALINGADDRESS maHrT802 E Mukilteo Blvd <br />rn Everett „Ai98203 Ewa <br />OWNER I MR. PHONE:425-308-39390 <br />OWNER I APP.EMAILbchenowetIT�7Qeverettwa.(JOV <br />'Required for Work In Public Righb4Way <br />CONTRACTOR NAME: Landscape Structures, Inc. <br />CONTRACTOR ADDRESS: rIE,601 nth Street South <br />m Delano STAw MN AP 55328 <br />CONTRACTOR PHONE:�2061932-6366 <br />CONTRACTOR EMNL:JOhOI@playCfeatl00.COm <br />CONTRACTOR LICENSE#(REQUIRED): LANDSS1973NQ <br />EvaaErr ausWEss OcaxsE gREoumeo): 44560 <br />PRIMARY CONTACT: 0 OWNER I APPLICANT ❑ OTHER(Archiect, Engineer, Etc.) <br />L❑CONTRACTOR <br />, <br />CONTACT NAME: Brad cnenoWeth <br />�j l <br />CONTACT PHONE:425-308-3939 <br />CON TACT EMAIL: bcbenoweM®gmail.mm <br />ACKNOWLEDGEMENT I here ranneastl this appNra(im antl wnrmm Me iMormation conhimd M1aeed is hue aM wins(. Wwk Mew pnsoanfro HAS PomAf must <br />soppy with currant iama, Sider and mall law. The Mounting wa panmi only augredaes apprwod work And no dawafmns ehemmem. Dewaimns moat post be <br />aNlMmtlln mi14g hwn Me Bulldem OMcbl be/ore being eNlMmd underany onam tainro. I am Me owner, al am wMorheo'by Me owner m`MH pmpety to <br />redeem iha work for Wycb application is nestle, and comply wear the State Coniradom' Law 1827 RCW and 266.200A WAC. <br />(,fly OFEwred OMceI Use only <br />BRADCHENOWETH TaWt;,'^0,`; ,`n"`,.rvO'""' <br />PW <br />OwneNAUNorlietl AgaM Signelure Daw (RMARWAT12022) <br />