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SEES PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT W-m- - .-„ <br />WISINGIONr�1eCTI KOIIMATMM F14T ' ,PS I AN r. <br />PROJECT SITE INFORMATION <br />PRQJECTADDNES: 70/6 G. <br />SITE WORK FOR PROJECT TYPE: OSFHOETFcxEO OLEWXMWSE OW nFa ORIU OMULTLF.WILS 19COMMERC,AL DIN WSTRM. <br />IF APPLICABLE: ❑ LAND USE PROJECT F IBEPA PRE-APP BG. ETC _ <br />IF APPLICABLE: QFRANCHISEAITWTY COMPMTI,.W NUAL BUNNET PERMIT F <br />UTILITY COMPANY9 NAME A JOB t JOB <br />DESCRIPTION OF SITE WORK I RIGHT-OF-WAY WORK <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />❑FENCE IN ROW FTIN HEIGHT <br />❑ DRIVEWAY APRON I CURB GUT FTWIDE <br />❑ ASPHALT I CONCRETE PAVING BE <br />❑ RETAINING WALL I ROCKERY IN RIGHTOFAMAY _LF <br />❑RETAININGWAUL I ROCKERY OVER AFT IN HEIGHT _FTTOTALHEIGHT <br />❑J CLEARING I SPACING I FILL I EXCAVATE OY <br />LJ GUPBORE IN PAVEMENT (PAPALIEL) LF <br />D OUTIBORE IN PAVEMENT INON-PARALLEL) LF <br />❑ POLE WORK I AERIAL I OVERIABH LF <br />ADDITIONAL DESCPoPTpX AB NEEDED: <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO <br />13c,m,Mi Caw, <br />ElSagmaa SUM yvr <br />D EMA DaMarya_w Smrommn Rrvno, Pyn mwe _ <br />TRIGGERED REQUIREMENTS <br />OMR]Orny OMRroS ElmPE _ <br />OUAMIN OF PROPOSED HARD SURFACES <br />eroaH Reed d„ SF <br />Mpm,Ad Mnea pa SF <br />Total RmI RIplond SF <br />CONTACT INFORMATION <br />WNER I APPLICANT NAME: $vn <br />WNER IAPP. MAILING ADDRESS: G <br />Sm <br />E./WFf re UAA ID FeJUS <br />WNER IAPP. PHONE: <br />OWNER IAPR EMAIL: <br />-RaeuA@Jmr WM m FlMc RMnwLWaY <br />ONTRACTORNAME Li +�+ M <br />CONTRACTOR ADDRESS: <br />ES <br />c an VA n, TbM4n <br />]CONTRACTOR PHONE: W,S- %O-9 S, <br />TONTRACTOR EMAIL G..n.yg iIP A <br />ONTRACTOROCENSEMREOUIREDC 4XAN bNo <br />EVEPIilTMU51ME58 LICENSE yREO Ul <br />PRIMARY CONTACT: DOWNER/APPLICANT OLCONTRACTOR ❑ OTHER A Rwct Enp,mrt. E4) <br />ONNTACT NAME: <br />gltn l.� LJ. tl tf <br />CONTACT PNOHE: _ 2 <br />CONTACT EMAIL: <br />ILVOWIEOGEMENi Ilr,wnwwM IM,PoA'+rmn,Munlmm mambrm,mn roM.vr,elrvm,n Ma,M een,[r WI*MdIpum1INfvM;pmmHmidt <br />mmpryxn Mn ,wMmu,pprvW wA,Mm tl,vr,Mne MaraRem b <br />nYaxmrolllwpmpMm <br />p.,mm.,w,.wr,m.n.ppu<.rmrr..m,e.,.elINN <br />Fa�nn�ezr Rrcw ease mw wnc� <br />CryolEwwloMnMVV Orry <br />PW <br />Orm,IIA.t"ev eANN Ae^,lur, 0,1, (R,MAe Vtmaza <br />