1802 75TH ST SW 2023-12-26 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMRl INSTRUCTIONS: Email xnplect S wombei documents We or drtp C11 at Seat Crew aheN One Fear Drop So WASHPINGTON CONTACT INFORMATION. (P) 425 25T 88101(E) PCrmuServlcesgovaralMa.gw l lw)evmetlxa.pw/Pormilr PROJECT SITE INFORMATION PROJECT ADDRESS: 1802 75th S1 SW Everett, WA 98203 SITE WORK FOR PROJECT TYPE: OSFR-DETACHED OTOWNHOUSE 0DUPI rx DADU OMW TI-FAMILY @COMMERCIAL OINDUSTRIAL IF APPLICABLE: O LAND USE PROJECT N (SEPA, PRE-APP, SS. ETC.) IFAPPLIOABLE: LdFRANCHISE/11TILI1Y COMPANY, ANNUAL BLANKET PERMIT UTILITY COMPANY'S NAME B JOB Y: JOB C: 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 I CURB CUT FT WIDE O ASPHALT I CONCRETE PAVING SF ❑ RETAINING WALL I ROCKERY IN RIGHT-0E-WAY LF ❑ RETAINING WALL I ROCKERY OVER JET IN HEIGHT FT TOTAL HEIGHT ❑ CLEARING) GRADING) FILL I ERCAVATE CY ❑ CUTWRE IN PAVEMENT(PARALLEL) LF ❑ CUUBORE IN PAVEMENT( NON -PARALLEL) LF ❑ POLE WORK I AERIAL I OVERLASH LF ADmTIONALDESCRIPTIONIAS NEEDED): DRAINAGE MITIGATION QUESTIONS: STORMWATER DISCHARGES TO: Oopmocrat Sewer O SePsrated Slolm Sever O Direct Distllarpe tO SmMmism River or Puget Sound TRIGGEREDREQUIREMENTS: QMBOOnly OMRPS OMI QUANTITY OF PROPOSED HARD SURFACES: Proposed Real Area: SF PropxeE Hemerope: BE Total New, Replaced. SF Replacing Dur North Vehicle Entry Gate to our Operations Center site. This will include removal of the current automatic gate ano operator, BUDcosta anon o new gate an operator, along with other sensors/safety devices as CONTACT INFORMATION OWNER I APPLICANT NAME: Public Eftildy Distinct No. I of Snobomisb County OWNER IARE. MAILING ADDRESS ITREETPO. Box 1107 ci Everett �TATE WA zip N206 OWNER IMP. PHONE:(425) 758-5963 OWNERI"P. EMAIL: kkwedfall@anopuacom 'Required for Work In Public Righto! Way CONTRACTOR NAME: AutolOatic Door and Gate CONTRACTOR ADDRESS AREUT 4014136th St NE r.; Marysvllle STAM WA ap 98271 CONTRACTOR PHONE: (425) 2596559 CONTRACTOR EMAIL: errybdPautodoorantlgate.com CONTRACTOR LICENSE LNREDUIREm: AUTOMUG935LK EVEaErr Buswess ucexsE gREDD]RED): BAYHAJABT4P2 PRIMARY CONTACT: 9OWNER IAP{PLICANT ❑CONTRACTOR ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME:KaSBy WeStfall CONTACT PHONE p251 1585963 CONTACT EMAIL uwealBrmTwewn ACKNOWLEDGEMENT I have reviewed this Apdrcafian and confirm Me information mnhimd M1erem is hue am pert. Warr dorw pxsuantM Mis parcel must mmp/y with current re derel,slate, and hical lawOne gremmg w a panuil only auliwmed approved poor and rm dawagerms they .. 0evialrona mcct post ea aNlMmd M mil4g hen Me Bulldmg OMcb/bNote being aNlMmd Laur sty cvrtumslanro. lam be owner, a1 am arReduradby Me oworeodlM1ispmpaty to pe orm Orke work for Mush appYcefion is made, and I comply year the State Contactors Law 1827 ROW eM 266.2004 WAC. Cry of Everett OMnal Use QMy FIEKMI KASEY WESTFALL 5/3/2023 IPW 19 Ownerbolth ized Agent signature Dow (ReWedW21,2022)