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PUBLIC WORKS PERMIT APPLICATION <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA M201 <br />(P)425-257-8810 I FAX425-257-8857 (E)everetlepseevereKwa.govl hfps//everetMa.gov/pormils <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 114M SILVER LAKE RD <br />SITE WORK FOR PRQIECT WPE: I]SFROETACHEO UTOWNHOUSE CIWPLEK QAW QMULTFFAMILY OCO.NI.IERCNL DINWSTWAL <br />IF APPLICABLE: ❑ IAND USE PROJECT#(SEPA, PRE-APP, SS ETC.) <br />IFAPPLICABLE: ❑HRANCHISF"LIWCOMPANY,ANNUALBLANKETPERMIT# <br />UTILITY COMPANY'S NAME 8 JOBM JOB 0 <br />DESCRIPTION OF SITE WORK / RIGHT-OF-WAY <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />CI FENCE IN ROW FT IN HEIGHT <br />❑DRIVEWAYAPRONICURBCUT FTWIDE <br />m ASPHALTICONCRETEPAViNG 15,433 BF <br />❑ RETAINING WALL I ROCKERY IN RIGHT-OF-WAY LF <br />❑ RETAINING WALL I ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br />® CLEARING /GRADING I FILL/EXCAVATE 124 CY <br />❑ CUTISORE IN PAVEMENT(PARALLEL) LF <br />❑ CUTHORE IN PAVEMENT(NONJ'ARALLPI) LF <br />❑POLEWORKIAERIAL/OVERIASH LF <br />ADDITIONAL DESCNPTION AB NEEDED: <br />WORK <br />DRAINAGE MITIGATION QUESTIONS: <br />STQRMWAIER DISCHARGES TO: <br />❑Omwbwd Sewer <br />❑S[pneYE Slum Sorer <br />❑Wad DNdwrye to SmM1omkh Rder Or Feet Sound <br />TRIGGERED REQUpgEMENTS: <br />0MR20Ny Dmi 0hii <br />gUANRTV OF PROPOSED HARD SURFACES: <br />pmpmed Rom Axe: aF <br />Pmemed Haldsnyg15,433 sF <br />Tout Nexawplawd:2g,598 SF <br />Silver Lake Trail Project <br />CONTACT INFORMATION <br />OWNERIAPPLICANT NAME: Clly Of Everett - Parks and Facilities Depararent <br />OWNER/APP. MAILING ADDRESS: Sabra 02 E MukiNeo Blvd <br />any Everett STAM WA .p 98203 <br />OWNER APP. PHONE: 4253284594 <br />OWNER/APP. EMAIL: dshaughnessy@everefta.gov <br />'Poland! for Woh In Public Righlal-Way <br />CONTRACTORNAME: <br />CONTRACTORADDRESS: <br />CON1UWGTORPHONE: <br />CONTRACTOREMAL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />EVERETT BUSINESS LICENSE MREQUIREI)h <br />PRIMARYCONTACT: mOWNER/APPLICANT []CONTRACTOR ❑OTHER(ArchiMcl,Engineer Etc.) <br />CONTACT NAME: <br />CONTACT PHONE:425 32845941425 257-8376 <br />Dean Shaughnessy I Brad Chenmvafh <br />CONTACT EMNL: dshaughnessy@everetMa.gov/bchenoweth@everelMa.gov <br />ACKNOWTECGEMENi I have, renewed Mk eJppaeEhl and wn the Information comelned M1neln is two end corral. Wwk done purcuenl In lMa permit mual <br />comlJy On commit lederel, aHN, and mcd law. no Mail of e p Mary euMmtres eppmvcd work and an deviations Melar . Cerupms mart and be <br />authorized i"far from Me SwFNnp g ced maker Moore mMmved under any Nrtumstance. l am the owner, or am Mohamed by tar Owner aWia prywly l0 <br />perform Me anmb concert application is made, and I camply wei Me Slate Owerea rs Lew 1627AC11 and 296.2001 WAC. <br />LNyWEYereM OIfiWIUae (arty <br />PERMIT# <br />Dean Shaughnessy orionn bjmoo Oaipapeff <br />MaaePW 22b��b�-6 <br />OwnedAmed Agent Sigrwmre� Date fRewaed lnmleJ <br />