305 SE EVERETT MALL WAY BASE FILE 2023-12-28

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I https:Heverettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:305 SE EVERETT MALL WAY, EVERETT,WA 98208-3250 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ✓❑COMMERCIAL []INDUSTRIAL IF APPLICABLE: Ll LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) EPPLI CABLE: ElFRANCHISE/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: DRAINAGE MITIGATION QUESTIONS: ❑FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: ❑DRIVEWAY APRON/CURB CUT FT WIDE ❑ Combined Sewer s❑ASPHALT/CONCRETE PAVING 19 SF ❑ Separated Storm Sewer ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ Direct Discharge to Snohomish River or Puget Sound ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑ CLEARING/GRADING/FILL/EXCAVATE CY ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION (AS NEEDED): ITotal New+Replaced: SF Connect lower landing on new ADA ramp (on private property) to public side walk CONTACT INFORMATION OWNER/APPLICANT NAME:DOUG BEAN&ASSOCIATES, INC. (C.O. HANNAH ZAIDI-RAZVI) OWNER/APP. MAILING ADDRESS: STREET PO BOX 2519 CITY PORTLAND STATE OR ZIP 97208 OWNER/APP. PHONE:503-478-4887 OWNER/APP. EMAIL:HANNAH@DOUGBEAN.COM `Required for Work in Public Right-of-Way CONTRACTOR NAME: Curb PCOS CONTRACTOR ADDRESS: STREET 26818 232nd Ave SE cIn Maple Valley STATE WA ZIP 98038 CONTRACTOR PHONE:206-719-0466 CONTRACTOR EMAIL:dale@curbpros.net CONTRACTOR LICENSE#(REQUIRED):CURBPPL860N8 EVERETT BUSINESS LICENSE#(REQUIRED): in progress PRIMARY CONTACT: ❑ OWNER /APPLICANT ❑ CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) SCR Architects CONTACT NAME: CONTACT PHONE:206-458-7517 Scott Connor CONTACT EMAIL:SCOTT@SCR-ARCH.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.1 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. City of Everett Official Use Only PERMIT# Scott Connor4/6/21 PW Owner/Authorized Agent Signature 0 Date (Revised 1/72019)