2601 SUMMIT AVE BLDG F 2024-01-08

EVERETT WASHINGTON PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 i FAX 425-257-8857 i (E) everetteps@everettwa.gov i https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2604-2614 Summit Ave, Everett, WA 98201 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY ❑✓ COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) PW2109-057 EPPLICABLE: ❑ FRANCHISE/UTILITYCOMPANY, 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: ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON / CURB CUT FT WIDE ❑ ASPHALT / CONCRETE PAVING SF ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ✓❑ CLEARING / GRADING / FILL / EXCAVATE 250 CY for, ❑ CUT/BORE IN PAVEMENT (PARALLEL) LF permitting ❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF Only ❑ POLE WORK / AERIAL / OVERLASH LF ADDITIONAL DESCRIPTION (AS NEEDED): ITotal DRAINAGE MITIGATION QUESTIONS: STORMWA TER DISCHARGES TO: ❑ Combined Sewer Z Separated Storm Sewer ❑ Direct Discharge to Snohomish River or Puget Sound TRIGGERED REQUIREMENTS: ❑ MR2 Only ❑ MR1-5 ❑✓ MR1-9 QUANTITY OF PROPOSED HARD SURFACES: Proposed Roof Area: SF Proposed Hardscape: SF New+ Replaced: SF CONTACT INFORMATION OWNER / APPLICANT NAME: EVERGREEN RECOVERY CENTER OWNER / APP. MAILING ADDRESS: STREET PO BOX 12598 CITY EVERETT STATE WA Z,p 98206 OWNER / APP. PHONE: 425-258-2407 OWNER / APP. EMAIL: LGRANT@EVERGREENRC.ORG 'Required for Work in Public Right -of -Way CONTRACTOR NAME: Kirtley Cole Associates LLC (James Schwartz) CONTRACTOR ADDRESS: STREET2820 Oakes Ave Suite B CITY Everett STATE • ��/�� A ZIP 98204 CONTRACTOR PHONE: 425.493.5310 CONTRACTOR EMAIL: LGrant@evergreenrc.org, MGese@evergreenrc.org CONTRACTOR LICENSE #(REQUIRED): KIRTLAL951 BC EVERETT BUSINESS LICENSE #(REQUIRED): KIRTLAL951 BC PRIMARY CONTACT: ❑ OWNER / APPLICANT ❑ CONTRACTOR ❑✓ OTHER (Architect, Engineer, Etc.) Architect CONTACT NAME: Dawn Bushnaq CONTACT PHONE: (206) 963-6306 CONTACT EMAIL: DAWN@BUSHNAQ.STUDIO.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 theork 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 # 3 22 IPW Si nature Dat (Revised 1172019)