2310 23RD ST 2023-11-28 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: �'� s" f-)a jq T 2 Ci SITE WORK FOR PROJECT TYPE: SFR-DETACHED []TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY []COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# DESCRIPTION OF SITE WORK/ RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: ❑DRIVEWAY APRON/CURB CUT FT WIDE Combined Sewer ❑ASPHALT/CONCRETE PAVING SF ❑Separated Storm Sewer ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑Direct Discharge to Snohomish River or Puget Sound ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: CLEARING I GRADING I FILL/EXCAVATE �} CY ❑ MR2 Only ❑ MRI-5 ❑ MR1-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: rr jj SF ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: "l L�� SF ADDITIONAL DESCRIPTION(AS NEEDED); Total New+Replaced: SF CONTACT INFORMATION OWNER I APPLICANT NAME: e rL a_ L (._r OWNER/APP. MAILING ADDRESS: STREET alm r )r'c s t �}} CITY i v ILL—Q STATE w ZIP �`�L2 OWNER/APP.PHONE: ,y 6 C` ` 9 7 OWNER/APP.EMAIL: 't/Y) 't ��i �� lEi J G(1 'Required for Work in Public Right-of-Way l CONTRACTOR NAME: Z" I ) ' Le" )< ` CONTRACTOR ADDRESS: STREET CITY - STATE ZIP CONTRACTOR PHONE: qJJ --3 t (D " 6b07CONTRACTOR EMAIL: er LT)e u? IL 0. C /o- CONTRACTOR LICENSE#(REQUIRED): Q V E R,L?I b U t m 0 EVERETT BUSINESS LICENSE#( QUIRED): PRIMARY CONTACT: OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: < "k1e.-V-v)6r. , 1 lta 4�u- ,�CONTACT EMAIL: 9 -7 ACKNOWLEDGEMENT:(have reviewed this a plication 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 I am authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Oficial Use Only �-- i) -3 ipw Own r/Authorized Agent Signature Date (Revised 1/72019)