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 8208 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ✓❑COMMERCIAL []INDUSTRIAL IF APPLICABLE: Il 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 1,657 SF ❑ Separated Storm Sewer °❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY 16 LF ❑ Direct Discharge to Snohomish River or Puget Sound ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: s❑ CLEARING/GRADING/FILL/EXCAVATE 4 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): Total New+Replaced: SF striping and ada signs CONTACT INFORMATION OWNER/APPLICANT NAME:Danyelle Nys OWNER/APP. MAILING ADDRESS: STIEET12322 highwayy 99 suite 126 CITY everett STATE wa ZIP 98204 OWNER/APP. PHONE:4257663503 OWNER/APP. EMAIL:danyellei@nysenterprises.com `Required for Work in Public Right-of-Way CONTRACTOR NAME: Nys Enterprises CONTRACTOR ADDRESS: STREETsame above CITY STATE ZIP CONTRACTOR PHONE:4253552474 1CONTRACTOR EMAIL:danyelle@nysenterprises.com CONTRACTOR LICENSE#(REQUIRED):nysenl*107D6 IEVERETT BUSINESS LICENSE#(REQUIRED): 30226 PRIMARY CONTACT: F11 OWNER /APPLICANT ❑ CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE:4257663503 Danyelle Nys CONTACT EMAIL:danyelle@nysenterprises.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# Danyelle Nys 9/14/2021 IPW Owner/Authorized Agent Signature Date (Revised 1/72019)