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PUBLIC WORKS PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETTSUBMITTAL INSTRUCTIONS:Email application&submittal documents to PermitServices@everettwa.gov or drop off at 3200 Cedar Street 2nd Floor Drop Box <br /> WASHINGTON CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1312 Colby Ave <br /> SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> IF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# <br /> UTILITY COMPANY'S NAME&JOB#: JOB#: <br /> DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK <br /> FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: <br /> ❑ FENCE IN ROW FT IN HEIGHT STORMWA TER DISCHARGES TO: <br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ Combined Sewer <br /> ❑ASPHALT/CONCRETE PAVING SF ❑ Separated Storm Sewer <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ Direct Discharge to Snohomish River or Puget Sound <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: <br /> ❑ CLEARING/GRADING/FILL/EXCAVATE CY ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 <br /> ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF <br /> ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF <br /> ADDITIONAL DESCRIPTION (AS NEEDED): ITotal New+Replaced: SF <br /> Tree removal and replacement in right of way planting strip in front of house <br /> CONTACT INFORMATION <br /> OWNER/APPLICANT NAME:Cindy Luna <br /> OWNER/APP. MAILING ADDRESS: STREET1312 Colby Ave <br /> CITY Everett STATE WA Zip 98201 <br /> OWNER/APP. PHONE:206-683-2619 OWNER/APP. EMAIL:cindy.Iuna@Obiseafoods.com <br /> `Required for Work in Public Right-of-Way <br /> CONTRACTOR NAME: Ellzarldro Botello - B. Brothers Landscape <br /> CONTRACTOR ADDRESS: STREET706 Legion Drive <br /> CITY Everett STATE WA z,p 98201 <br /> CONTRACTOR PHONE:425-232-2102 1CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):BBROTBL788MM 1EVERETT BUSINESS LICENSE#(REQUIRED): BBROTBL788MM <br /> PRIMARY CONTACT: 8 OWNER /APPLICANT ❑ CONTRACTOR ❑ OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME:Cindy Luna CONTACT PHONE:206-683-2619 <br /> CONTACT EMAIL:elizandro.botello@bbrotherslandscape.com <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must <br /> 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 <br /> authorized in writing from the Building Official before being authorized under any circumstance. 1 am the owner,or l am authorized by the owner of this property to <br /> perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Cindy Luna 4/26/23 <br /> PERMIT <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br />