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PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETTSUBMIIALINSTRUCTIONa EmzadPparnlNnkanumnmla dun nmMae B.w a®w w gwwdmpa„M no Were M3ndE UDwp am <br />WASHINGTON CONTACT INFORMATION: (P)4P5-R574SIDI(E)PermlLServlcea®evereHwa lacy IIWI evereMa.novloeamlK <br />"PROJECT ,Will I NFO JCN <br />PROJECT ADDRESS <br />SITE WORK FOR PROJECT TYPE: OSFR-OETACHEO 13TOWNHOUSE ODUPLEX DADU OMULTI-FAMILY ®COMMERCIAL OINOUSTRIAL <br />IF APPLICABLE: ❑ LAND USE PROJECT# (SEPA, PRE-APP, SS, ETC.) <br />IF APPLICABLE: OFRANCHISENTILITY COMPANY, ANNUAL BLANKET PERMIT # <br />UTILITY COMPANY'S NAME & JOB M JOB#: <br />DESCRIP.TiOFI OF. SITE'4110RK I'AYOHiCOPr <br />FI ILL I N ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />❑ FENCE IN ROW FT IN HEIGHT <br />❑DRIVEWAY APRON/CURB CUT FTWIDE <br />1ASPHALT I CONCRETE PAVING iD,Q�D SF <br />❑RETAINING WALL/ ROCKERY IN RIGHT-OF-WAY _LF <br />❑RETAINING WALL ROCKERY OVER 4FT IN HEIGHT _FT TOTAL HEIGHT <br />❑ CLEARING I GRADING I FILL / EXCAVATE CY <br />❑ CIITIBORE IN PAVEMENT (PARALLEL) UP <br />❑ CUTISORE IN PAVEMENT (NON -PARALLEL) LF <br />❑POLE WORK AERIAL I OVERLgSH LF <br />ADDITIONALDESCRIPTION AB NEEDED: <br />11VA -W 'TM <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />13 Combined Sewer <br />0 Sepemled Sierra Server <br />17 Deal Dlecherge W SrnMmbh Race or Pulled Sound <br />TRIGGERED REQUIREMENTS: <br />13MSP OnN 17 MR14 ❑ MRI-g <br />QUANTITY OF PROPOSED HARD SURFACES <br />Propane RONAfel SF <br />Proposed HaNawpe: 6F <br />Tocel New+ Ra aced: SF <br />k B y <br />IIA <br />0 V <br />U - <br />vL w <br />-:� CONTACT, INFORMATIO <br />OWNER I APPLICANT NAME: L <br />OWNER/APP. MAILINGADDRESS: 8TREEi <br />K G ATATe V <br />OWNER I APP. PHONE: <br />JOWNER I APP, EMAIL: <br />'ReOulred for WMS In Public RlghLof-Way <br />CONTRACTORNAME: <br />CONTRACTOR ADDRESS: STREET <br />CITY ALATH ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE WREQUIRED): <br />EVERETT BUSINESS LICENSE NREO WRED):. <br />PRIMARY CONTACT: ❑ OWNER I APPLICANT ❑CONTRACTOR ❑ OTHER (ArchilelEgineer, Etc.) _ <br />CONTACT NAME: <br />CONTACT PHONE: <br />COMACT EMAIL: <br />Is APPvwrron ant GMmrr themlmmerkn cpMdrawr rem Is hue ant mrecl. Wank done pursuant to ew pemMmusl <br />romplY NSA currentftlal Mae; and kcal law I"WanAng Me pare( Or auMotlzea approved Work andno deWNbne Mare(mm CaNeA smeal Nsl he <br />eNMdmtlln vMtlrp hwn NA Reduce OMckl before beep aW horib r d endorsed tlrcumalence. I am Me omen, w I am a~Sr ad by Iha owner of INS properly 0 <br />Perfect NO crank fwWMclr apppwlkn/S undue, and Sam*mint HAS Send CmhacMs New 1&27 RCWarM 4&[IbA WAC. <br />Ctl yW EYeMI OMclel Ike OmY <br />23 p�1y230Ca-D17 <br />ownedArweNaedr®eur Slender, Date (Bohedff1AV y <br />