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PU•IC WORKS PERMIT ASPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:1318 75th St SE <br /> SITE WORK FOR PROJECT TYPE: ❑r SFR-DETACHED ❑TOWNHOUSE ['DUPLEX DADU OMULTI-FAMILY ❑COMMERCIAL ['INDUSTRIAL <br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# <br /> UTILITY COMPANY'S NAME&JOB#: JOB# <br /> DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK <br /> FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: <br /> ['FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: <br /> ❑DRIVEWAY APRON/CURB CUT FT WIDE ❑ Combined Sewer <br /> O ASPHALT/CONCRETE PAVING 912.12 SF El Separated Storm Sewer <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF El Direct Discharge to Snohomish River or Puget Sound <br /> ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: <br /> 0 CLEARING/GRADING/FILL/EXCAVATE 80 CY ❑ MR2 Only El MR1-5 0 MR1-9 <br /> 0 CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: <br /> ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: 1705 SF <br /> ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape:912.12 SF <br /> ADDITIONAL DESCRIPTION (AS NEEDED): Total New+Replaced:2617.12 SF <br /> Extending existing concrete driveway to accomodate for a 2 car garage entry. <br /> Excavating approximately about 80 CY(-364 SF @ 6')to accomodate for a bigger foundation than the <br /> existing structure being demolitioned(#D2201-001). <br /> CONTACT INFORMATION <br /> OWNER/APPLICANT NAME:Blue Moon Realty LLC <br /> OWNER/APP. MAILING ADDRESS: STREET4905 33rd St Ct NE <br /> CITY Tacoma STATE WA zIP 98422 <br /> OWNER/APP. PHONE:2533976393 OWNER/APP. EMAIL:BlueMoonRealty.wa@Gmail.com <br /> *Required for Work in Public Right-of-Way <br /> CONTRACTOR NAME: N/A-TBD <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: El OWNER /APPLICANT ❑ CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE:2533976393 <br /> Soniya Moon CONTACT EMAIL:Soheemoon.96@gmail.com <br /> ACKNOWLEDGEMENT:I have reviewed this application 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 granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be <br /> 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 <br /> perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 5 ' 1/26/2022 PW 22t71 .-- O S <br /> Owner/Authorized Agent Signature Date (Revised 1/72019) <br />