11200 EVERGREEN WAY 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-i 2^� "�o - -.� e.'h c � ---11200 EVERGREEN WAY 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: ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON / CURB CUT FT WIDE ❑ ASPHALT / CONCRETE PAVING 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 ❑ Separated Storm Sewer ❑ Direct Discharge to Snohomish River or Puget Sound TRIGGERED REQUIREMENTS: ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 QUANTITY OF PROPOSED HARD SURFACES: Proposed Roof Area: SF Proposed Hardscape: SF ITotal New+ Replaced: SF Installation and sampling of 2 groundwater monitoring wells in the right of way on Highway 99/Evergreen St CONTACT INFORMATION OWNER IAPPLICANT NAME:Arcadls U.S., Inc. OWNER / APP. MAILING ADDRESS: STREET 11 00OI ive Way CITY Seattle STATE WA Z,P 98101 OWNER/APP. PHONE:206.571 .7716 OWNER/APP. EMAIL: elizabeth.scheller@arcadls.Com `Required for Work in Public Right -of -Way CONTRACTOR NAME: Cascade Environmental Drilling CONTRACTOR ADDRESS: STREET19404 Woodinville Snohomish Road NE CWoodinville STATE WA ZIP 98072 QITY Q Q CONTRACTOR PHONE:425.466.8588 1CONTRACTOR EMAIL:kgobel@cascade-env.com CONTRACTOR LICENSE #(REQUIRED): CASCADL91 5O8 IEVERETT BUSINESS LICENSE #(REQUIRED): 47889 PRIMARY CONTACT: ❑ OWNER / APPPLICANT ❑ CONTRACTOR R OTHER (Architect, Engineer, Etc.) Geologist (Arcadis) CONTACT NAME: Elizabeth SChel let„ CONTACT PHONE:206.571 .771 6 CONTACT EMAIL: ellzabeth.scheller@arcadls.com 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 I 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. Elizabeth Scheller 10/31/2022 Owner/Authorized Agent Signature Date City of Everett Official Use Only PERMIT # PW (Revised 412112022)