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PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 <br />1WASHINGTON _ (P)425-257-8810 1 FAX425-257-8857 1(E)everetteps@everotlwa,govI https://everettwa.gov/permits <br />PROJECT SITS INFOIiMJ# Otis; m <br />PROJECT ADDRESS: 4325 Federal Ave, Everett, WA <br />SITE WORK FOR PROJECT TYPE: SFR-DETACHED 0TOWNHOU815 ODUPLEK QADU❑MULTI-FAMILY'❑COMMERCIAL OINDUSTRIAL. <br />IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, $S, ETC.) <br />IF APPLICABLE: ❑ FRANCHISE/UTILITYCOMPANY, ANNUAL BLANKET PERMIT# <br />UTILITY COMPANY'S NAME & JOB M JOB # <br />... , �E8CRIP'1'IpN OF:StTE WORK'/=RIf31iTKOFAWAY <br />.OfiiC;.. ,,. ,. <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />FENCE IN ROW 4.3 FT IN HEIGHT <br />❑ DRIVEWAY APRON / CURB CUT FT WIDE <br />❑ ASPHALT / CONCRETE PAVING SF <br />El RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF <br />0 RETAINING WALL / ROOKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br />C7 CLEARING I GRADING I FILL I EXCAVATE �uCY <br />O CUT/BORE IN PAVEMENT (PARALLEL) LF <br />O CUT/BORE IN PAVEMENT (NONPARALLEL) LF <br />❑ POLE WORK / AERIAL I OVERLASH LF <br />ADDITIONAL DESCRIPTION (AS NEEDED):. <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />❑ Combined Sewer <br />❑ separated storm sewer <br />C1 Direct Discharge to Snohomish River or Puget Sound <br />TRIGGERED REQUIREMENTS: <br />CI MR2Only 0 MR1-5 ❑ MR1-e <br />QUANTITY OF PROPOSED HARD SURFACES: <br />Proposed RootAnea: 5K <br />Proposed Hardscape: SF <br />Total Now+Replaced: SF <br />T L% <br />CdMTACTIMFQRM1Afi1QN. <br />OWNER I APPLICANT NAME: John and Crystal BaUSCh <br />OWNER /APP, MAILING ADDRESS: SMELT. 4325 Federal Ave <br />cffy Everett STATE WA zip 98203 <br />OWNER/APP. PHONE: 206-739-8986 <br />JOWNERIAPP., EMAIL: JOhrlbeusch@OUtI00It.Com <br />'Requlred for Work in Pubilc Right-ot-Way <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET <br />My STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />1EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ( OWNER /:APPLICANT ❑ CONTRACTOR ❑ OTHER (Archlteot,Engineer, Etc.) <br />CONTACT NAME: <br />John Bausch � <br />CONTACT PHONE: 206-139-8986 <br />CONTACT EMAIL: Johnbausch@outlook.com <br />ACKNOWLEDGEMENT, I have reviewed this appllcation and confirm the Information contained herein Is true and correct Work done pursuant to this permit must <br />comply with current federal, state, and local law. The craning of a permit only authorizes approved work and no deviations.. therefrom Deviations must first be <br />authorized In writing from the Building Offiolat before being authorized under any circumstance. I am the owner, or am authorized by theowner of this property to <br />perform the work for which application is made, and I comply with the State Contractors Lew 10,; 7RCWand 46.200A WAC. <br />Clty of Everett 01170101 UW only. <br />PMIT# <br />PW <br />(R vked 1/7019) _ <br />