4101 RUCKER AVE 2024-01-26 - Laserfiche WebLink

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:4101 Rucker Avenue Everett, WA 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 ❑ASPHALT/CONCRETE PAVING 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 Install ten soil borinqs in the ROW of 41st Street as shown on the attached maps. The soil borings will be backfilled with benotinite and patched to match the surroundinq asphalt. CONTACT INFORMATION OWNER/APPLICANT NAME: Nick Gerkin c/o Aerotech Environmental Consulting Inc. OWNER/APP. MAILINGADDRESS: STIEET14220 Interurban Avenue S, Ste 116 CITY Tukwila STATE WA 1,98168 OWNER/APP. PHONE:206-482-2287 OWNER/APP. EMAIL:nick@dirtydirt.us `Required for Work in Public Right-of-Way CONTRACTOR NAME: B&W Standard Probe LLC CONTRACTOR ADDRESS: STIEET211 171 st Street South, Unit C CITY Spanawav STATE W�Q` ZIP 98387-8732 CONTRACTOR PHONE:916-206-0867 CONTRACTOR EMAIL:bwstandardprobe@gmail.com CONTRACTOR LICENSE#(REQUIRED):BWSTASP78202 EVERETT BUSINESS LICENSE#(REQUIRED): 66651 PRIMARY CONTACT: F11 OWNER /APPLICANT ❑ CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE:2064822287 Nick Gerkin CONTACT EMAIL:nick@dirtydirt.us 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# 11/02/2023 IPW Owner/Authorized Agent Signature Date (Revised 1/72019)