3602 EARL AVE 2024-03-05 - Laserfiche WebLink

rw PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EV E R E T T SUBMITTAL INSTRUCTIONS: Email application 8 submittal documents to PermitServlces®everettwa.gov or drop off at 3200 Cedar Street 2nd Floor Drop Box WASHINGTON CONTACT INFORMATION: (P) 425-257-88101 (E) PermltServlces@everettwa.gov I (W) everettwa.gov/permits PROJECT WE INFORMATION PROJECT ADDRESS: 02 �1/Q , 4 SITE WORK FOR PROJECT TYPE: FR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT It (SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT # UTILITY COMPANY'S NAME & JOB M JOB M 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 ��]" Y l C� ASPHALT! CONCRETE PAVING / _ SF y�H `�5 ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑ CLEARING / GRADING I 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: 0 MR2 Only ❑ MR1-5 ❑ MR1-9 QUANTITY OF PROPOSED HARD SURFACES: Proposed Roof Area: SF Proposed Hardscape: SF Total New+ Replaced: SF CONTACT, INFORMATION OWNER / APPLICANT NAME: 1&1E a Tam e4 OWNER / APP. MAILING ADDRESS: STREET 0 7 _ Cm 9 rj O STATTE WX ZIP OWNER / APP. PHON : 7c� �t�!— Q (O 6 OWNER / APP. EMAIL: 'Required for Work in Public Right -of -Way CONTRACTOR NAME: Sax % �a 7a_klet, _C ALC 17R XCO CONTRACTOR ADDRESS: STREET CRY (/ �Q_WA STATE ZIP O CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: -OWNER / APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: Q/SCL P J' C /YlCir C,OYrL ACKNOWLEDGEMENT I have reviewed this application and confirm the information contained herein is true and correct. Work d e 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. / 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. City of Everett Official Use Only PERMIT AU-� - ipw Own orized t ure Date (Revised 4/21/2022)