4805 EVERGREEN WAY 2023-10-18 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL INSTRUCTIONS:Email application&submittal documents to PermitServices@everettwa.gov or drop off at 3200 Cedar Street 2nd Floor Drop Box WASHINGTON CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everettwa.gov I(W)everetlwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:4805 Evergreen Way SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY INCOMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) r LICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB M JOB M DESCRIPTION OF SITE WORK/ RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑ FENCE IN ROW 0 FT IN HEIGHT STORMWATER DISCHARGES TO: ❑ DRIVEWAY APRON/CURB CUT 0 FT WIDE ❑ Combined Sewer ❑ASPHALT/CONCRETE PAVING 0 SF ❑Separated Storm Sewer ❑RETAINING WALL I ROCKERY IN RIGHT-OF-WAY 0 LF ❑Direct Discharge to Snohomish River or Puget Sound ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT 0 FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑CLEARING I GRADING I FILL/EXCAVATE 0 CY ❑ MR2 Only ❑MR1-5 ❑ MRI-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) 0 LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) 0 LF Proposed Roof Area:0 SF ❑ POLE WORK/AERIAL/OVERLASH 0 LF Proposed Hardscape:0 SF ADDITIONAL DESCRIPTION(AS NEEDED): iTotal New+Replaced:0 SF Decommission historic approximately 750-gallon heating oil UST. UST will be pumped and rinsed using existing fill port, and decommissionedy placing approximately four cubic yards of CDF using existing fill port. Environmental eansultant pfeviously advanced be i Ry af US:F and results of sell saffiPle analyses did n nd'rate release to subsurface sool. CONTACT INFORMATION OWNER/APPLICANT NAME:Clearcreek Contractors,a division of Holt Services,Inc. OWNER I APP. MAILING ADDRESS: STREET PO Box 1659 cny Milton STATE WA ZIP 98354 OWNER I APP.PHONE:253.604.4878 OWNER I APP.EMAIL:dness@holtservicesinc.com 'Required for Work in Public Right-of-Way CONTRACTOR NAME: Clearcreek Contractors,a division of Holt Services, Inc. CONTRACTOR ADDRESS: STREET 10621 Todd Road East cm Edgewood STATE WA ZIP 98372 CONTRACTOR PHONE:253.604.4878CONTRACTOR EMAIL:dness@holtservicesinc.com CONTRACTOR LICENSE#(REQUIRED):HOLTSSI898JG EVERETT BUSINESS LICENSE#(REQUIRED): 052763 PRIMARY CONTACT: ❑OWNER /APPLICANT B CONTRACTOR ❑OTHER(Architect,Engineer,Etc.) CONTACT NAME: CONTACT PHONE:206.549.4080 Darren Ness CONTACT EMAIL:dness@holtservicesin.com ACKNOWLEDGEMENT I 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only Darren R. Ness� ya "�nR�u' 2/13/2023 PERMIT eN C•VS.E+dx.s$Axae�kasre cem WMi,SUJn,. Ouit—c�,.�, • San a PW -00 eae N2]OI.13105).OILe0P Owner/Authorized Agent Signature Date (Revised 4/21/2022) b?Nofiqte, A -77iV K v..►f