11415 AIRPORT RD 2023-11-28 - Laserfiche WebLink

Sf-QA 19-,020 t® EVERETT WASHINGTON PUBLIC WORKS PERMIT APPLICATION a"ffiq CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I hUps://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 11517 Airport Rd Everett WA 98204 11 q15 4i c- o r � oQ SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) EAPPLICABLE: ❑ FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT # UTILITY COMPANY'S NAME & JOB M JOB # DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON / CURB CUT FT WIDE ❑ ASPHALT I CONCRETE PAVING SF ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT © CLEARING / GRADING / FILL / EXCAVATE CY ❑ CUT/BORE IN PAVEMENT (PARALLEL) LF ❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF ❑ POLE WORK / AERIAL / OVERLASH LF ADDITIONAL DESCRIPTION (AS NEEDED): DRAINAGE MITIGATION QUESTIONS: STORMWATER DISCHARGES TO: ❑ Combined Sewer ❑ Separated Storm Sewer ❑ Direct Discharge to Snohomish River or Puget Sound TRIGGERED REQUIREMENTS: ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 QUANTITY OF PROPOSED HARD SURFACES: Proposed Roof Area: SF Proposed Hardscape: SF Total New + Replaced: SF Clearinq black berry bush and small tree usinq excator. CONTACT INFORMATION OWNER / APPLICANT NAME: Kaye Enterprises Inc OWNER / APP. MAILING ADDRESS: STREET 131 128th St SW cnY Everett STATE WA ZIP 98204 OWNER / APP. PHONE: (206)852-1415 OWNER / APP. EMAIL: Lee@smjmanagement.com `Required for Work in Public Right -of -Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CI Y STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: © OWNER / APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) CONTACT NAME: Pyu n g Lee CONTACT PHONE: (206)852-1415 CONTACT EMAIL: Lee@smjmanagement.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 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. Signature 3/21 /2022 Date City of Everett Official Use Only PERMIT # PW 2203 - 020 (Revised 1/72019)