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PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETTSUBMnT INSTRUCTIONS: Email Miami B submlMl commands PermM1ServlwaMee'renrMa.go, At dad all at 3200 Olds eheN 2nd Bad Coca Raw <br />WASIVINGTON CONTACT INFORMATION. EX 02125T-88101DE) PerTaSarvicesipeverameap wI(W)wmetlxa pw/Pormils <br />PROJECT BITE INFORMATION <br />'REJECT ADDRESS: Senator Henry M. Jackson Park- 330218th St., Everett, WA <br />SITE WORK FOR PROJECT TYPE: OSFR-DETACHED OTOWNHOUSE 0DUPLEX OADU 0MULTIFAMILY @COMMERCIAL OINDUETRIAL <br />IF APPLICABLE: O LAND USE PROJECT N (SEPA, PRE-APP, SS. ETC.) <br />IFAPPLIOABLE: QFRANCHISENTILITY COMPANY, ANNUAL BLANKET PERMIT <br />UTILITY COMPANY'S NAME B JOB It: BeJIt: <br />DESCRIPTION OF 81 <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />@ FENCE IN ROW FT IN HEIGHT <br />❑ DRIVEWAY APRON I CURB CUT FTWIDE <br />■ ASPHALT I CONCRETE PAVING 144 SF <br />❑ RETAINING WALL I ROCKERY IN RIGHT-0E-WAY LF <br />❑ RETAINING WALL I ROCKERY OVER JET IN HEIGHT FT TOTAL HEIGHT <br />❑ CLEARING) GRADING) FILL I ERCAVATE OY <br />O CUTWRE IN PAVEMENT( PARALLEL) LF <br />O CUTWRE IN PAVEMENT( NON -PARALLEL) LE <br />❑ POLE WORK I AERIAL I OVERLASH LF <br />ADDITIONAL DESCRIPTION AS NEEDED): <br />F-WAY WORK <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />OOombined Slower <br />■ reperaled Stan Swrer <br />O Damn Discharge to economist River or Paget Sound <br />TRIGGEREDREQUIREMENTS: <br />EMBOOnly QMR1-5 [31 1A <br />QUANTITY OF PROPOSED HARD SURFACES: <br />Promoted Rood Area SF <br />Prorssed Herdscape: 144 BE <br />Total Had a Replaced t 4I SF <br />Project will install lancing and concrete entry pad for an off -leash dog area in an area along Chestnut St. at the <br />non ati jai Pei It. <br />CONTACT INFORMATION <br />OWNER I APPLICANT NAME:EVerett Parks/ Katherine Phillips <br />OWNER I ARE. MAILING ADDRESS mREu802 E. Mukilteo Blvd. <br />TY Everett XTATE WA ZIP98203 <br />OWNERIAPP. PHONE: 425.626.0217 <br />OWNERIAPP.EMML:kphllllps@everettWa.gov <br />'Required for WaM In Public Righto! Way <br />CONTRACTOR NAME: Everett Parks Maintenance/Asa Sholdez <br />CONTRACTOR ADDRESS: m[cr802 E. Mukilteo Blvd. <br />,r Everett erAMWA ap 98203 <br />coNTRAcroR PxoxE:425.257.8377 CONTRACTOR EMAILasholdez@everettvai <br />CONTRACTOR LICENSE INREQUIRED): <br />EVERETT BUSINESS LICENSE u(REQUIREB): <br />PRIMARY CONTACT: 0 OWNER I APPLICANT ❑CONTRACTOR ❑ OTHER(Architect, Engineer, Etc.) <br />CONTACT NAME: <br />Katl Ierll�e PIIIIIIpS <br />CONTACT PNO NE:425.626.U21] <br />CONTACT EMNL:hpM1illipelIDeveredded We <br />ACKNOWLEDGEMENT I Mre revierwtl thisappNzafimaMwn(mm Me iMormation mnhimO M1emn is huaaM zamz(. Wady Mrwpxsuanlro Mk PoaraMmlut <br />comply warm awrenl kdeml. addler and ucai law. The gran ding of a pamril oy audiwmes approved wool ant no dawaruns thereM1um, nawadmna mwt tarn be <br />eNlMmd M mXNg flwn Me Bulldmg OMcbibNors being eNlMmtl Under any cvrtumslenro. I am OR owner, atwo wModmtl by Me owradithis pmpaty, to <br />random lire emak Er whi application is made, and comply watt the State Conhectom' Law 1827 RCW eM 266.2004 HAD. <br />Clry o/ Ewned OMnel Use Gray <br />PIRII <br />11/18/2022 PW <br />OwneNAUNorizetl Ag SeWMre Daie (ReARMUC212022) <br />