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PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETTSUMARTAL INSTRUCTIONS:DN0ApA[mbi A%I4<Bm.nbb Poiml9tMxe$eewlMgr"drop oR41220 GAINS MM 2M Five Drop AM <br />WASHINGTON CONTACT INFORMATION: (P)I2S25i-0910I(E) PermllServlceeBQBvemlM.gov l ON) WastMagov/pmmlt4 <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 2816 Baker Avenue Everett, We 98201 <br />SITE WORK FOR PROJECT TYPE: OSFR-DETACHED OTOWNHOUSE DnUPLEx OAOU OMULTI.FAMILY I1ICOMMERCIAL DINDUsTRIM <br />IF APPLICABLE: ❑ IAND USE PROJECT# SEPA PRE -APE, SS, ETC. <br />IFAPPLICABLE: ❑FRANCHISEAITIUTY COMPANY, ANNUAL BLANKET PERMIT <br />UTILITY COMPANY'S NAME& JOB If. JOB#: <br />DESCRIPTION OF SITE WORK / RIGHT -OF- <br />AN WORK <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />❑FENCE IN ROW FT IN HEIGHT <br />El DRIVEWAY APRON/CURB CUT FTWIDE <br />❑ ASPHALT I CONCRETE PAVING SF <br />❑RETAINING WALL/ ROCKERY IN RIGHT-0E-WAY ELF <br />O RETAINING WALL ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br />■ CLEARING /GRADING I FILL/EXCAVATE 72 CY <br />❑ CUT/aORE IN PAVEMENT (PARALLEL) LF <br />❑ CUTMORE IN PAVEMEW(NON-PARALLEL) LF <br />❑POLE WORK/AERIAL/OVERLASH LF <br />ADDITIONAL DESCRIPTION AS NEEDED: <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />13Ccuawnei Seem; <br />■ Sepemui swim sewer <br />_❑DIMS Dis"Ne, U Gmhomieh Rlwr a Pupn Sound <br />TRIGGERED REQUIREMENTS: <br />OMR20W 13wH-5 OMR1-S <br />QUANTITY OF PROPOSED HARD SURFACES: <br />PHoosnd RBBPAree:D SP <br />P¢ sed HaORmpdD SF <br />17091 New, Repload 0 SF <br />CONTACT INFORMATION <br />OWNER/APPLICANTNAME: Phoenix Building LLC <br />OWNER IMP. MAJLINGADDRESS: CHRIST 2815Baker Ave. <br />Everett , We w 98201 <br />OWNER I APP. PHONE: 206-2908518m <br />IOWNERIAPP.EMAIL:DanielaphOenlKartreStOrallon. CORI <br />'Reyulmd Mr Work In FMIc RIgMUT-Wey <br />CONTRACTOR NAME: Line 8. Grade COnstrudon LLC <br />CONTRACTOR ADDRESS: .,7122 83rd PI ne <br />m Me villa ALAN We C,98270 <br />CONTRACTOR PHONE:350-223-8491 CONTRACTOR EMAIL: "COns""Cl1@gmail.COm A/ <br />CONTRACTOR LICENSE REoulNEDLINEGGC831 M1 <br />EVERETT 5US1NESS LICENSE VIREOUIRED):R <br />PRIMARY CONTACT: ❑OW N,IERIAPPLIC,IANT ®CONTRACTOR ❑ OTHER (Architect, Engineer. EIC) <br />CONTACT NAME:ErIC Edmondson <br />CONTACT PHONE:380.223-Mil <br />CONTACT EMAIL:pBgmbuMl®gmell.cam <br />ACHNOWLEDGEMENPIhewreNevretllhbeppMcelbn BndwMrm the InMmellm vvnlelnBtlllorein Is IAS cmn[P WorhtlmBpur4uenl bfM1l4permRmutl <br />camplywUh current bOereI,4MIB. MdAGWIMw. RagamlMpo/spemM only eulhahret eppmwDewhentl rro Javellms(hand! .OevNlMnsmu4l linl be <br />eWwA%G hn wrllMpfiom Mo RWppg Oflklelbelm bang eulhodAd untlolany c4mmielonce. l em IMcwner, orl em su(Mlidtl by Me cwnero/IM1lsproperlylo <br />AHNAGS nwwh pM"eppl ftmend,B lcomplyWfhthe Shh Cmhs vLewl&21RCWe 2N2 WAC. <br />I /I/ I aryolerema mlmutr Gmy <br />-& �&oW 6& I(Iz,(zp�3 PW Z3ol <br />Owner/Aomorlva Agent elanaNN "a (RBM%d A/Tl2&22f <br />