3302 18th ST 2024-03-05 - 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: DRAINAGE MITIGATION QUESTIONS: 8 FENCE IN ROW FT IN HEIGHT STORMWA TER DISCHARGES TO: ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ Combined Sewer 8 ASPHALT/CONCRETE PAVING 144 SF 8 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 91MR2 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:0 SF ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape:144 SF ADDITIONAL DESCRIPTION (AS NEEDED): 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 OWNER/APP. EMAIL:kphllllps@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 CONTRACTOR EMAIL:asholdeZ@everettwa.gov CONTRACTOR LICENSE#(REQUIRED): 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 4/21/2022)