3302 18th ST 2025-05-14 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL INSTRUCTIONS: Email application & submittal documents to PermitServices@everettwa.gov or drop off at 3200 Cedar Street 2nd Floor Drop Box WASHINGTON CONTACT INFORMATION: (P) 425-257-8810 1 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: Senator Henry M. Jackson Park - 3302 18th St., Everett, WA SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY RCOMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT # UTILITY COMPANY'S NAME & JOB #: JOB #: DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: 8 FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON / CURB CUT FT WIDE 8 ASPHALT / CONCRETE PAVING 144 SF ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑ CLEARING / GRADING / FILL / EXCAVATE CY ❑ CUT/BORE IN PAVEMENT (PARALLEL) LF ❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF ❑ POLE WORK / AERIAL / OVERLASH LF ADDITIONAL DESCRIPTION (AS NEEDED): DRAINAGE MITIGATION QUESTIONS: STORMWA TER DISCHARGES TO: ❑ Combined Sewer 8 Separated Storm Sewer ❑ Direct Discharge to Snohomish River or Puget Sound TRIGGERED REQUIREMENTS: 91MR2 Only ❑ MR1-5 ❑ MR1-9 QUANTITY OF PROPOSED HARD SURFACES: Proposed Roof Area:0 SF Proposed Hardscape: 144 SF ITotal New+ Replaced: 144 SF Project will install fencing and concrete entry pad for an off -leash dog area in an area along Chestnut St. at the CONTACT INFORMATION OWNER/APPLICANT NAME:Everett Parks/ Katherine Phillips OWNER / APP. MAILING ADDRESS: STIEET802 E. Mukilteo Blvd. CITY Everett STATE Y V\/�/, Q ` ZIp 98203 OWNER / APP. PHONE:425.626.0217 1OWNER / APP. EMAIL: kphillipS@everettwa.gov `Required for Work in Public Right -of -Way CONTRACTOR NAME: Everett Parks Maintenance/Asa SholdeZ CONTRACTOR ADDRESS: STIEET802 E. Mukilteo Blvd. CITY Everett STATE WA ZIP 98203 CONTRACTOR PHONE:425.257.8377 1CONTRACTOR EMAIL:aSholdez@everettwa.gov CONTRACTOR LICENSE #(REQUIRED): I EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: @ OWNER / APPLICANT ElCONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) CONTACT NAME: Katherine P h I I I I ps CONTACT PHONE:425.626.0217 CONTACT EMAIL:kphillips@everettwa.gov 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 l 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 _�e 11 /18/2022 pW # Owner/Authorized Agent Signature Date (Revised 412112022)